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Access Recirculation Stenosis — ESENeph MCQ

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ModerateHaemodialysisAccess Recirculation StenosisESENeph

A 58-year-old woman with CKD G5D on haemodialysis has an access recirculation of 25% measured by thermodilution. Her blood flow during dialysis is suboptimal and dialysis adequacy (spKt/V) has fallen to 0.9. What is the most likely cause?

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Correct answer: E — Venous outflow stenosis causing access recirculation

Access recirculation >5% (ideally <5%) indicates that dialysed blood is re-entering the dialyser rather than returning to the systemic circulation. The most common cause is venous outflow stenosis, which increases venous pressure and causes already-dialysed blood to recirculate back through the access. Other causes include incorrect needle placement (arterial and venous needles too close or reversed). High recirculation reduces effective dialysis dose (spKt/V). Investigation with fistulography and treatment of stenosis (angioplasty) is needed.

Reference: UKKA 2019 – Vascular Access; KDOQI 2019 – VA Update