Background: Measurement of ionic dialysance has been shown to accurately determine urea dialyzer clearance and vascular access flow rate (Qa) in diffusive hemodialysis. Recently, online clearance monitoring (OCM) in an online hemodiafiltration (OL-HDF) machine could accurately measure urea dialyzer clearance. In the present study, OCM was utilized to assess the Qa in OL-HDF. Methods: In 32 stable end-stage renal disease patients undergoing predilution OL-HDF, the values of Qa measured by the OCM technique (QaOCMT) in a Fresenius 4008H HDF machine were compared with those determined by the standard ultrasound dilution technique (QaUDT). Results: The values of QaUDT and QaOCMT measured at the beginning of the HDF session were 800.5 ± 910.3 and 794.6 ± 895.4 ml/min (nonsignificant). There was a significant correlation between the two techniques (r = 0.95, p < 0.01). A Bland-Altman plot demonstrated a good agreement. Conclusion: The vascular access flow determined by OCM, which is integrated mostly in the current HDF machine, is highly accurate, easy to perform, and economical and can be used for vascular access surveillance in OL-HDF.

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