An on line clearance monitor automated for measurements of conductivity dia
lysance (Dcn) was used to measure blood access flow rate (cnQac) during hem
odialysis. From mathematical analysis of transport, it was shown that cnQac
e = [(Dcn*Decn)/(Dcn - Decn)] [1/bwf], where Dcn is measured with standard
cocurrent flow of dialyzer blood (Qb) and Qac; Decn is measured with counte
rcurrent Qb/Qac; and bwf is fractional blood water content. An identical eq
uation was derived to measure Qac from urea dialysance (uQac, Du, Deu). In
vitro studies showed excellent correlation between volumetric measurement o
f Qac (vQac) and cnQac, r = 0.98, n = 29, and between uQac and cnQac, r = 0
.97, n = 28. In vivo studies showed comparable agreement between uQac and c
nQacc, r = 0.97, n = 14. In two of the patients studied, there was unsuspec
ted severe midgraft stenosis (no recirculation in cocurrent flow) with a Qa
c of 89 and 202 ml/min disclosed by both cnQac and uQac measurements. Mathe
matical analysis also showed that when Qb is greater than Qac and there is
recirculation in cocurrent flow, the above equations always return the valu
e Qac = Qb. An equation was derived to calculate cnQac without reversal of
blood lines in this case, using Dcn calculated from the dialyzer transport
coefficient and flow rates.