An example medical system includes a hemodialysis device configured to receive blood from vasculature of a patient via an arterial line and to deliver blood to the vasculature of the patient via a venous line. The medical system includes a hematocrit sensor configured to generate a signal indicative of a hematocrit level of blood in at least one of the arterial line or the venous line. The medical system also includes processing circuitry configured to determine a change in blood volume of the patient over time based on the signal indicative of the hematocrit level, determine a threshold blood volume reduction over time for the patient, compare the change in the blood volume of the patient over time to the threshold blood volume reduction over time, and based on the comparison, generate an indication of vascular access recirculation.