Arteriovenous Fistula, Blood Flow, Cardiac Output, and Left Ventricle Load in Hemodialysis Patients

Válek, Martin; Lopot, František; Polakovič, Vladimír

doi:10.1097/mat.0b013e3181ce6757

Cited by 14 publications

(18 citation statements)

References 8 publications

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“…The arteriovenous access and the systemic circulation are connected in a parallel way, as shown in Figure . Then, SVR can be calculated as follows: SVR (mm Hg·min/L) = MAP/(CO−Qa)…”

Section: The Impact Of An Arteriovenous Access On Hemodynamic and Cirmentioning

confidence: 99%

The complex relationship among arteriovenous access, heart, and circulation

Basile

Lomonte

2017

Seminars in Dialysis

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There are currently near 400 000 patients on hemodialysis in the United States. More than 50% of those treated by chronic hemodialysis die because of a cardiovascular (CV) event. The majority of these patients have functional arteriovenous fistulas (AVFs).AVFs have an adverse effect on cardiac function, but their exact contribution to CV morbidity is not clear. It has long been known that a vascular access with an inappropriately high-flow rate may cause high-output heart failure. Paradoxically, there may be hemodynamic and cardiopulmonary benefits conferred by AVF particularly in severe chronic obstructive pulmonary disease. While Brescia-Cimino`s basic idea of the AVF has saved millions of lives, we would like to stress that there are dangers from their often high blood flow rates, which unfortunately have proved difficult to evaluate.

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“…The arteriovenous access and the systemic circulation are connected in a parallel way, as shown in Figure . Then, SVR can be calculated as follows: SVR (mm Hg·min/L) = MAP/(CO−Qa)…”

Section: The Impact Of An Arteriovenous Access On Hemodynamic and Cirmentioning

confidence: 99%

The complex relationship among arteriovenous access, heart, and circulation

Basile

Lomonte

2017

Seminars in Dialysis

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“…The aim of the present observational cross-sectional study was to further our understanding of haemodynamic modifications of the cardiovascular (CV) system of HD patients associated with an AVF. The specific objective of the present study was to calculate using real data in what way an AVF influences the load of the left ventricle (LLV), particularly in patients bearing an AVF with a high Qa, on the principle of a simple physical model [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system

et al. 2016

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BackgroundSatisfactory vascular access flow (Qa) of an arteriovenous fistula (AVF) is necessary for haemodialysis (HD) adequacy. The aim of the present study was to further our understanding of haemodynamic modifications of the cardiovascular system of HD patients associated with an AVF. The main objective was to calculate using real data in what way an AVF influences the load of the left ventricle (LLV).MethodsAll HD patients treated in our dialysis unit and bearing an AVF were enrolled into the present observational cross-sectional study. Fifty-six patients bore a lower arm AVF and 30 an upper arm AVF. Qa and cardiac output (CO) were measured by means of the ultrasound dilution Transonic Hemodialysis Monitor HD02. Mean arterial pressure (MAP) was calculated; total peripheral vascular resistance (TPVR) was calculated as MAP/CO; resistance of AVF (AR) and systemic vascular resistance (SVR) are connected in parallel and were respectively calculated as AR = MAP/Qa and SVR = MAP/(CO − Qa). LLV was calculated on the principle of a simple physical model: LLV (watt) = TPVR·CO2. The latter was computationally divided into the part spent to run Qa through the AVF (LLVAVF) and that part ensuring the flow (CO − Qa) through the vascular system. The data from the 86 AVFs were analysed by categorizing them into lower and upper arm AVFs.ResultsMean Qa, CO, MAP, TPVR, LLV and LLVAVF of the 86 AVFs were, respectively, 1.3 (0.6 SD) L/min, 6.3 (1.3) L/min, 92.7 (13.9) mmHg, 14.9 (3.9) mmHg·min/L, 1.3 (0.6) watt and 19.7 (3.1)% of LLV. A statistically significant increase of Qa, CO, LLV and LLVAVF and a statistically significant decrease of TPVR, AR and SVR of upper arm AVFs compared with lower arm AVFs was shown. A third-order polynomial regression model best fitted the relationship between Qa and LLV for the entire cohort (R2 = 0.546; P < 0.0001) and for both lower (R2 = 0.181; P < 0.01) and upper arm AVFs (R2 = 0.663; P < 0.0001). LLVAVF calculated as % of LLV rose with increasing Qa according to a quadratic polynomial regression model, but only in lower arm AVFs. On the contrary, no statistically significant relationship was found between the two parameters in upper arm AVFs, even if mean LLVAVF was statistically significantly higher in upper arm AVFs (P < 0.0001).ConclusionsOur observational cross-sectional study describes statistically significant haemodynamic modifications of the CV system associated to an AVF. Moreover, a quadratic polynomial regression model best fits the relationship between LLVAVF and Qa, but only in lower arm AVFs.

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“…In our previous study, we measured differences in cardiac output before and after the first AVF surgery, as well as the blood flow rates in several sites in the arm with AVF; we found that the blood flow rates in the brachial artery correlated most strongly with increases in cardiac output 13. Válek et al examined the association between VA blood flow and load on the left ventricle by using an ultrasound dilution technique (with an HD01 monitor, Transonic, Taoyuan, Taiwan) and noted that increase in access blood flow increased heart load 14. Sites of anastomosis of AVFs are not suitable for blood flow measurement because turbulent blood flow is likely to occur at them.…”

Section: Discussionmentioning

confidence: 99%

Brachial artery blood flow measurement: A simple and noninvasive method to evaluate the need for arteriovenous fistula repair

Ogawa

Matsumura

Matsuda

et al. 2011

Dialysis & Transplantation

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OBJECTIVE: The objective of this study was to evaluate the utility of brachial artery blood fl ow measurement in assessing the need for arteriovenous fi stula (AVF) repair. METHODS:In 236 hemodialysis patients, the relationships between the brachial artery blood fl ow measurement results and subsequent AVF repair and prognosis were investigated. RESULTS: Mean brachial artery blood fl ow was signifi cantly lower in patients requiring percutaneous transluminal angioplasty (PTA; treatment group, n = 161) than in patients followed without any treatment (no treatment group, n = 64; 250.3 mL/min versus 656.7 mL/min, p < 0.0001). When the relationship between the mean brachial artery blood fl ow and PTA requirement was analyzed using the ROC curve, the optimal cut-off value with high sensitivity (true-positive fraction [TPF]) and 1-specifi city (false-positive fraction [FPF]) was 348.8 mL/min (area under the ROC curve = 0.814, FPF = 0.125, TPF = 0.87).CONCLUSIONS: Decreased brachial artery blood fl ow of <350 mL/min is associated with the need for subsequent AVF repair, suggesting that this simple and noninvasive method could be used to evaluate vascular access (VA) patency and indication for AVF repair.

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Arteriovenous Fistula, Blood Flow, Cardiac Output, and Left Ventricle Load in Hemodialysis Patients

Cited by 14 publications

References 8 publications

The complex relationship among arteriovenous access, heart, and circulation

The complex relationship among arteriovenous access, heart, and circulation

The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system

Brachial artery blood flow measurement: A simple and noninvasive method to evaluate the need for arteriovenous fistula repair

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