title: Arterial line pressure control enhanced extracorporeal blood flow prescription in hemodialysis patients.
abstract: BACKGROUND
  In hemodialysis, extracorporeal blood flow (Qb) recommendation is 300-500 mL/min. To achieve the best Qb, we based our prescription on dynamic arterial line pressure (DALP).
  
  
  METHODS
  This prospective study included 72 patients with catheter Group 1 (G1), 1877 treatments and 35 arterio-venous (AV) fistulae Group 2 (G2), 1868 treatments. The dialysis staff was trained to prescribe Qb sufficient to obtain DALP between -200 to -250 mmHg. We measured ionic clearance (IK: mL/min), access recirculation, DALP (mmHg) and Qb (mL/min). Six prescription zones were identified: from an optimal A zone (Qb > 400, DALP -200 to -250) to zones with lower Qb E (Qb < 300, DALP -200 to -250) and F (Qb < 300, DALP > -199).
  
  
  RESULTS
  Treatments distribution in A was 695 (37%) in G1 vs. 704 (37.7%) in G2 (P = 0.7). In B 150 (8%) in G1 vs. 458 (24.5%) in G2 (P < 0.0001). Recirculation in A was 10.0% (Inter quartile rank, IQR 6.5, 14.2) in G1 vs. 9.8% (IQR 7.5, 14.1) in G2 (P = 0.62). IK in A was 214 +/- 34 (G1) vs. 213 +/- 35 (G2) (P = 0.65). IK Anova between G2 zones was: A vs. C and D (P < 0.000001). Staff prescription adherence was 81.3% (G1) vs. 84.1% (G2) (P = 0.02).
  
  
  CONCLUSIONS
  In conclusion, an optimal Qb can de prescribed with DALP of -200 mmHg. Staff adherence to DLAP treatment prescription could be reached up to 81.3% in catheters and 84.1% in AV fistulae.
authors.affiliation: Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico. franklin.mora.bravo@gmail.com
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Mora-Bravo
authors.forename: Alfonso
authors.initials: A
authors.lastname: Mariscal
authors.forename: Juan P
authors.initials: JP
authors.lastname: Herrera-Felix
authors.forename: Salvador
authors.initials: S
authors.lastname: Magaña
authors.forename: Guadalupe
authors.initials: G
authors.lastname: De-La-Cruz
authors.forename: Nelly
authors.initials: N
authors.lastname: Flores
authors.forename: Laura
authors.initials: L
authors.lastname: Rosales
authors.forename: Martha
authors.initials: M
authors.lastname: Franco
authors.forename: Héctor
authors.initials: H
authors.lastname: Pérez-Grovas
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome