Skip to main content

Advertisement

SpringerLink
Log in

Single needle hemodialysis: is the past the future?

  • Review
  • Published:
Journal of Nephrology Aims and scope Submit manuscript

Abstract

Whereas the usual way to gain access to the vascular bed for hemodialysis is by inserting two needles, an alternative option based on the introduction of only one needle has been available for several decades. Although single needle hemodialysis gradually lost popularity in the early nineties of last century, this option now seems to make a come-back, with the current change in patient mix towards more elderly and cardio-vascular disease and the appearance of more flexible hardware. Single needle hemodialysis offers several advantages, such as the possibility to puncture small or maturing access systems, a decrease in number of punctures with less potential access damage and subsequent complications, the avoidance of central vein catheter use, and an improved quality of life by reducing puncture-related pain, stress and complications. The main drawback is recirculation which however can be overcome (if considered necessary) by making dialysis somewhat longer and in addition has more impact on removal of small water soluble compounds than on clearance of the more toxic difficult to remove solutes (middle molecules and protein bound compounds). Effective dialyzer blood flow with single needle dialysis cannot be much higher than 300 mL/min, which however also offers advantages by making short dialysis sessions less feasible and thus reducing the likelihood of intradialytic blood pressure falls, organ stunning and other negative outcomes of shorter dialysis. Direct outcome comparisons between single and double needle dialysis are not available but indirect data suggest no differences, in as far as efficient enough access perfusion can keep dialyzer blood flow adequate. The single needle method seems especially suited for the elderly and for home hemodialysis. Recent technological improvements have made the system more accessible and adequate, but further studies are needed to assess with modern methodologies the clearance kinetics of these systems, which could emanate in further technological fine-tuning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kopp KF, Gutch CF, Kolff WJ (1972) Single needle dialysis. Trans Am Soc Artif Intern Organs 18:75–81

    CAS  PubMed  Google Scholar 

  2. Vanholder R, Hoenich NA, Ringoir S (1989) Single needle haemodialysis. In: Maher JF (ed) Replacement of renal function by dialysis. Kluwer Academic Publishers, Dordrecht, pp 382–399

    Google Scholar 

  3. Bieser W, Welsch M, Jakob M et al (2018) Effectiveness of a new single-needle single-pump dialysis system with simultaneous monitoring of dialysis dose. Artif Organs 42(8):814–823

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Konner K, Nonnast-Daniel B, Ritz E (2003) The arteriovenous fistula. J Am Soc Nephrol 14(6):1669–1680

    PubMed  Google Scholar 

  5. van Loon MM, Kessels AG, Van der Sande FM, Tordoir JH (2009) Cannulation and vascular access-related complications in hemodialysis: factors determining successful cannulation. Hemodial Int Int Symp Home Hemodial 13(4):498–504

    Google Scholar 

  6. Ervo R (2013) Novita nella dialisi at ago singolo. G Ital Nefrol 30(3):1–11

    Google Scholar 

  7. Tordoir JH, van Loon MM, Peppelenbosch N, Bode AS, Poeze M, van der Sande FM (2010) Surgical techniques to improve cannulation of hemodialysis vascular access. Eur J Vasc Endovasc Surg 39(3):333–339

    CAS  PubMed  Google Scholar 

  8. Gallieni M, Hollenbeck M, Inston N et al (2019) Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 34(Suppl 2):ii1–ii42

    PubMed  Google Scholar 

  9. Vanholder R, Van Biesen W, Fox JG, Nagler EV (2019) The new European Renal Best Practice guideline on arteriovenous access: why worthwhile to read. Nephrol Dial Transplant 34(7):1071–1074

    PubMed  Google Scholar 

  10. Siddiqui MA, Ashraff S, Carline T (2017) Maturation of arteriovenous fistula: analysis of key factors. Kidney Res Clin Pract 36(4):318–328

    PubMed  PubMed Central  Google Scholar 

  11. Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN (2007) A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 45(2):420–426

    PubMed  Google Scholar 

  12. Ceretta ML, Noordzij M, Luxardo R et al (2018) Changes in co-morbidity pattern in patients starting renal replacement therapy in Europe-data from the ERA-EDTA Registry. Nephrol Dial Transplant 33(10):1794–1804

    CAS  PubMed  Google Scholar 

  13. Kurella M, Covinsky KE, Collins AJ, Chertow GM (2007) Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med 146(3):177–183

    PubMed  Google Scholar 

  14. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK (2001) Type of vascular access and mortality in US hemodialysis patients. Kidney Int 60(4):1443–1451

    CAS  PubMed  Google Scholar 

  15. Pastan S, Soucie JM, McClellan WM (2002) Vascular access and increased risk of death among hemodialysis patients. Kidney Int 62(2):620–626

    PubMed  Google Scholar 

  16. Rayner HC, Pisoni RL, Gillespie BW et al (2003) Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int 63(1):323–330

    PubMed  Google Scholar 

  17. Moon JY, Lee HM, Lee SH et al (2015) Hyperphosphatemia is associated with patency loss of arteriovenous fistula after 1 year of hemodialysis. Kidney Res Clin Pract 34(1):41–46

    PubMed  PubMed Central  Google Scholar 

  18. Parisotto MT, Pelliccia F, Grassmann A, Marcelli D (2017) Elements of dialysis nursing practice associated with successful cannulation: result of an international survey. J Vasc Access 18(2):114–119

    PubMed  Google Scholar 

  19. Lee T, Barker J, Allon M (2006) Needle infiltration of arteriovenous fistulae in hemodialysis: risk factors and consequences. Am J Kidney Dis 47(6):1020–1026

    PubMed  Google Scholar 

  20. Group FHNT, Chertow GM, Levin NW et al (2010) In-center hemodialysis six times per week versus three times per week. N Engl J Med 363(24):2287–2300

    Google Scholar 

  21. Vanholder R, Hoenich N, Ringoir S (1987) Adequacy studies of fistula single-needle dialysis. Am J Kidney Dis 10(6):417–426

    CAS  PubMed  Google Scholar 

  22. De Clippele M, Vanholder R, De Roose J, Derom F, Ringoir S (1983) Fistula survival in single needle hemodialysis. Int J Artif Organs 6(2):71–73

    PubMed  Google Scholar 

  23. Wilson B, Harwood L, Thompson B (2009) Impact of single-needle therapy in new chronic hemodialysis starts for individuals with arteriovenous fistulae. CANNT J 19(2):23–28

    PubMed  Google Scholar 

  24. Xue JL, Dahl D, Ebben JP, Collins AJ (2003) The association of initial hemodialysis access type with mortality outcomes in elderly Medicare ESRD patients. Am J Kidney Dis 42(5):1013–1019

    PubMed  Google Scholar 

  25. Brown RS, Patibandla BK, Goldfarb-Rumyantzev AS (2017) The survival benefit of “Fistula First, Catheter Last” in hemodialysis is primarily due to patient factors. J Am Soc Nephrol 28(2):645–652

    PubMed  Google Scholar 

  26. Menon V, Greene T, Wang X et al (2005) C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int 68(2):766–772

    CAS  PubMed  Google Scholar 

  27. Yeun JY, Levine RA, Mantadilok V, Kaysen GA (2000) C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 35(3):469–476

    CAS  PubMed  Google Scholar 

  28. Goldstein SL, Ikizler TA, Zappitelli M, Silverstein DM, Ayus JC (2009) Non-infected hemodialysis catheters are associated with increased inflammation compared to arteriovenous fistulas. Kidney Int 76(10):1063–1069

    PubMed  Google Scholar 

  29. Manns B, Hemmelgarn B, Lillie E et al (2014) Setting research priorities for patients on or nearing dialysis. Clin J Am Soc Nephrol 9(10):1813–1821

    PubMed  PubMed Central  Google Scholar 

  30. Viecelli AK, Tong A, O’Lone E et al (2018) Report of the standardized outcomes in nephrology-hemodialysis (SONG-HD) consensus workshop on establishing a core outcome measure for hemodialysis vascular access. Am J Kidney Dis 71(5):690–700

    PubMed  Google Scholar 

  31. Viecelli AK, O’Lone E, Sautenet B et al (2018) Vascular access outcomes reported in maintenance hemodialysis trials: a systematic review. Am J Kidney Dis 71(3):382–391

    PubMed  Google Scholar 

  32. Bay WH, Van Cleef S, Owens M (1998) The hemodialysis access: preferences and concerns of patients, dialysis nurses and technicians, and physicians. Am J Nephrol 18(5):379–383

    CAS  PubMed  Google Scholar 

  33. Taylor MJ, Hanson CS, Casey JR, Craig JC, Harris D, Tong A (2016) “You know your own fistula, it becomes a part of you”—patient perspectives on vascular access: a semistructured interview study. Hemodial Int Int Symp Home Hemodial 20(1):5–14

    Google Scholar 

  34. Viecelli A, Howell M, Tong A et al (2019) Identifying critically important vascular access outcomes for trials in haemodialysis: an international survey with patients, caregivers and health professionals. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfz148

    Article  Google Scholar 

  35. Vanholder R, Hoenich N, Bogaert AM, Ringoir S (1986) Long-term experience with routine single-needle dialysis. A review. ASAIO Trans 32(1):300–304

    CAS  PubMed  Google Scholar 

  36. Meijer JH, Reulen JP, Schneider H, Oe PL, Koolen MI (1979) Analysis of recirculation in single-needle haemodialysis. Med Biol Eng Comput 17(5):578–582

    CAS  PubMed  Google Scholar 

  37. Ringoir S, Piron M, Vanholder R (1984) Conventional single needle hemodialysis. In: Ringoir S, Vanholder R, Ivanovich P (eds) First international symposium on single-needle dialysis. ISAO Press, Cleveland, pp 80–88

    Google Scholar 

  38. Saran R, Bragg-Gresham JL, Levin NW et al (2006) Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS. Kidney Int 69(7):1222–1228

    CAS  PubMed  Google Scholar 

  39. Flythe JE, Curhan GC, Brunelli SM (2013) Disentangling the ultrafiltration rate-mortality association: the respective roles of session length and weight gain. Clin J Am Soc Nephrol 8(7):1151–1161

    PubMed  PubMed Central  Google Scholar 

  40. Flythe JE, Curhan GC, Brunelli SM (2013) Shorter length dialysis sessions are associated with increased mortality, independent of body weight. Kidney Int 83(1):104–113

    PubMed  Google Scholar 

  41. Burton JO, Jefferies HJ, Selby NM, McIntyre CW (2009) Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol 4(5):914–920

    PubMed  PubMed Central  Google Scholar 

  42. Eldehni MT, Odudu A, McIntyre CW (2015) Randomized clinical trial of dialysate cooling and effects on brain white matter. J Am Soc Nephrol 26(4):957–965

    CAS  PubMed  Google Scholar 

  43. Eloot S, Van Biesen W, Dhondt A et al (2008) Impact of hemodialysis duration on the removal of uremic retention solutes. Kidney Int 73(6):765–770

    CAS  PubMed  Google Scholar 

  44. Blumenthal SS, Ortiz MA, Kleinman JG, Piering WF (1986) Inflow time and recirculation in single-needle hemodialysis. Am J Kidney Dis 8(3):202–206

    CAS  PubMed  Google Scholar 

  45. Vanholder R, Hoenich N, Ringoir S (1982) Dialysis performance of single lumen subclavian hemodialysis: a comparative study with single lumen fistula hemodialysis. Artif Organs 6(4):429–432

    CAS  PubMed  Google Scholar 

  46. Vanholder RHN, Piron M, Billiouw JM, Ringoir S (1983) Haemodialysis in a single and a two needle vascular access system: a comparative study. Proc Eur Dial Transplant Assoc 20:176–180

    CAS  PubMed  Google Scholar 

  47. Vanholder R, Pletinck A, Schepers E, Glorieux G (2018) Biochemical and clinical impact of organic uremic retention solutes: a comprehensive update. Toxins 10(1):33

    PubMed Central  Google Scholar 

  48. Evenepoel P, Rodriguez M, Ketteler M (2014) Laboratory abnormalities in CKD-MBD: markers, predictors, or mediators of disease? Semin Nephrol 34(2):151–163

    CAS  PubMed  Google Scholar 

  49. DeSoi CA, Umans JG (1993) Phosphate kinetics during high-flux hemodialysis. J Am Soc Nephrol 4(5):1214–1218

    CAS  PubMed  Google Scholar 

  50. Rostoker G, Griuncelli M, Loridon C, Bourlet T, Welsch K, Benmaadi A (2009) Improving the efficiency of short-term single-needle hemodialysis. Ren Fail 31(4):261–266

    CAS  PubMed  Google Scholar 

  51. Tattersall J (2017) Hemodialysis time and Kt/V: less may be better. Semin Dial 30(1):10–14

    PubMed  Google Scholar 

  52. Tattersall J (2013) Do we need another Kt/V? Nephrol Dial Transpl 28(8):1963–1966

    Google Scholar 

  53. Vanholder R, Glorieux G, Eloot S (2015) Once upon a time in dialysis: the last days of Kt/V? Kidney Int 88(3):460–465

    CAS  PubMed  Google Scholar 

  54. Vanholder R, Van Biesen W, Lameire N (2019) A swan song for Kt/Vurea. Semin Dial 32(5):424–437

    PubMed  Google Scholar 

  55. Basile C, Lomonte C (2012) Kt/V urea does not tell it all. Nephrol Dial Transplant 27(4):1284–1287

    PubMed  Google Scholar 

  56. Gotch FA, Sargent JA (1985) A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). Kidney Int 28(3):526–534

    CAS  PubMed  Google Scholar 

  57. Tattersall J, Martin-Malo A, Pedrini L et al (2007) EBPG guideline on dialysis strategies. Nephrol Dial Transplant 22(Suppl 2):ii5–ii21

    PubMed  Google Scholar 

  58. Ervo R (2011) Extracorporeal dialysis: techniques and adequacy. NDT Plus 4(suppl 2):4.s2.37

    Google Scholar 

  59. Trakarnvanich T, Chirananthavat T, Ariyakulnimit S, Maneerat P, Chabsuwan S (2006) The efficacy of single-needle versus double-needle hemodialysis in chronic renal failure. J Med Assoc Thai 89(Suppl 2):S196–S206

    PubMed  Google Scholar 

  60. Trakarnvanich T, Chirananthavat T, Maneerat P, Chabsuwan S, Areeyakulnimit S (2007) Is single-needle hemodialysis still a good treatment in end-stage renal disease? Blood Purif 25(5–6):490–496

    PubMed  Google Scholar 

  61. Dhaene M, Gulbis B, Lietaer N et al (1989) Red blood cell destruction in single-needle dialysis. Clin Nephrol 31(6):327–331

    CAS  PubMed  Google Scholar 

  62. Kumar S, Bandyopadhyay U (2005) Free heme toxicity and its detoxification systems in human. Toxicol Lett 157(3):175–188

    CAS  PubMed  Google Scholar 

  63. Schaer DJ, Buehler PW, Alayash AI, Belcher JD, Vercellotti GM (2013) Hemolysis and free hemoglobin revisited: exploring hemoglobin and hemin scavengers as a novel class of therapeutic proteins. Blood 121(8):1276–1284

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Grooteman MP, van den Dorpel MA, Bots ML et al (2012) Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol 23(6):1087–1096

    CAS  PubMed  PubMed Central  Google Scholar 

  65. Morena M, Jaussent A, Chalabi L et al (2017) Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly. Kidney Int 91(6):1495–1509

    PubMed  Google Scholar 

  66. Maduell F, Moreso F, Pons M et al (2013) High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol 24(3):487–497

    PubMed  PubMed Central  Google Scholar 

  67. Ok E, Asci G, Toz H et al (2013) Mortality and cardiovascular events in online hemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study. Nephrol Dial Transplant 28(1):192–202

    PubMed  Google Scholar 

  68. Lowrie EG, Laird NM, Parker TF, Sargent JA (1981) Effect of the hemodialysis prescription of patient morbidity: report from the National Cooperative Dialysis Study. N Engl J Med 305(20):1176–1181

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nephrology Section, 0K12, Department of Internal Medicine, University Hospital Ghent, C Heymanslaan, 10, 9000, Ghent, Belgium

    Raymond Vanholder

Authors
  1. Raymond Vanholder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raymond Vanholder.

Ethics declarations

Conflict of interest

Raymond Vanholder received travel support and speakers honoraria from BBraun.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vanholder, R. Single needle hemodialysis: is the past the future?. J Nephrol 33, 49–58 (2020). https://doi.org/10.1007/s40620-019-00644-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40620-019-00644-9

Keywords

Search

Navigation