Incidence of arteriovenous fistula closure due to high‐output cardiac failure in kidney‐transplanted patients

Schier, Tabea; Göbel, Georg; Bösmüller, Claudia; Gruber, I; Tiefenthaler, Martin

doi:10.1111/ctr.12248

Cited by 35 publications

(41 citation statements)

References 16 publications

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“…Echocardiographic data for our patients were also not available.The assessment of cardiac load was mostly clinical. This and our research shows that the need to close AVF in patients with kidney stones is not uncommon 59 30 . In our study of other reasons for the closure of AVF, except cardiac overload were aneurysmatic dilatation in 21% of them and hand oedema in 4% of patients, while in research conducted by Schier et al only two ligation were related to flow, but one was due to aesthetic reasons and the other due to infection 59 .…”

Section: Discussionsupporting

confidence: 66%

“…Since the blood flow is faster through the AVF, which are on the upper arms but the forearms 60 , so is the "closure" of AVF in the research of Schier et al more often in those patients with AVFs on the upper arms.We do not have information on the exact localization of the AVF on hand for our patients and no data on the flow rate through the AVF. Vascular surgeons did not want to do the AVF ligation if there were no pathological findings in echocardiography in these patients, and the most common pathological findings on echocardiography were pulmonary hypertension and right ventricular dilatation 59 . Echocardiographic data for our patients were also not available.The assessment of cardiac load was mostly clinical.…”

Section: Discussionmentioning

confidence: 99%

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Arteriovenous Fistula After Kidney Transplantation in University Hospital Centre Osijek

Jurić

Zibar

2019

Rad Hrvatske akademije znanosti i umjetnosti

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Aims: To examine the proportion of patients with thrombosis or surgical ligation of arteriovenous fistula (AVF) after kidney transplantation (TX) and to explore the time passed after the TX until the loss of AVF function. Patients and methods: The study design was historical cohort study. The study included all 123 patients (57.7 % men, median age 58 years, from 34 to 79) that underwent kidney TX in the University Hospital Centre Osijek during the first 10 years of practicing that kind of surgery in the hospital. The data on AVF function, thrombosis or ligation were undertaken from medical records, along with demographics (age, gender, time after TX). The data were presented descriptively and after statistical analysis that was performed using SPSS (version 17.0). Results: FunctionalAVF immediately prior to TX was found in 78 % of the patients. The AVF was still functional in 39.84 % of all patients for 3 years (median, interquartile range, IQR 0 -3) after TX. AVF thrombosis happened in 17.89 %, while surgical ligation was performed in 20.33 % of all patients. The most common reason for ligation was increased risk of heart failure (in 75 % of the ligations), followed by aneurysmatic dilatation and arm swelling. Median time after TX to thrombosis or ligation of AVF was 2 years, IQR 0 -3. Thrombosis or ligations were significantly more frequent in women. The outcome of AVF after kidney TX was not related to the patient's age. Conclusion: AVF after kidney TX often became nonfunctional, either after spontaneous thrombosis or after surgical ligation, which was required for increased heart failure risk in the majority of the cases. Sažetak:Arterijskovenskih fistula nakon bubrežnog presađivanja u Kliničkom bolničkom centru Osijek Cilj: Istražiti udio ispitanika u kojih je nakon bubrežnog presađivanja (transplantacije, TX) došlo do tromboze ili ligacije arterijskovenske fistule (AVF) te istražiti vrijeme nakon TX-a u kojemu je došlo do gubitka funkcije AVF-a. Ispitanici i postupci: Istraživanje je ustrojeno kao kohortno povijesno istraživanje.Uključeno je svih 123 bolesnika (57,7 % muških, medijana dobi 58 godina, od 34 do 79) kojima je bubrežni presadak transplantiran u Kliničkom bolničkom centru Osijek tijekom prvih 10 godina otkako se u toj bolnici vrši bubrežni TX. Iz medicinskih zapisa preuzeti su podaci o funkciji AVF-a, trombozama i ligacijama, kao i demografski podatci (dob, spol, vrijeme nakon TX-a). Podaci su prikazani deskriptivno i analitički, a statistički obrađeni pomoću SPSS-a (inačica 17.0). Rezultati: AVF neposredno prije TX-a imalo je 78 % bolesnika. Još uvijek funkcionira u 39,84 % svih ispitanika, 3 godine (medijan, interkvartilni raspon, IQR od 0 do 3) nakon TX-a. Tromboza AVF-a je nastupila u njih 17,89 %, a ligacija je izvedena u 20,33 % svih ispitanika. Najčešći razlog ligacije AVF-a u našem istraživanju bio je srčano opterećenje (u 75 % ligacija), zatim aneurizmatična dilatacija AVF-a te otok ruke. Vrijeme nakon TX-a do tromboze ili ligacije bilo je medijana 2 godine (IQR 0 -3). Tromboza ili liga...

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Arteriovenous Fistula After Kidney Transplantation in University Hospital Centre Osijek

Jurić

Zibar

2019

Rad Hrvatske akademije znanosti i umjetnosti

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“…One of the important functions of hemodialysis is the removal of excess fluid from the body by means of ultrafiltration . In the current study, we found that body weight was significantly decreased at t − 30 than t + 30, which should be attributed to the removal of excess fluid by ultrafiltration.…”

Section: Discussionsupporting

confidence: 52%

Effect of Blood Pump Flow and Arteriovenous Fistula Blood Flow on the Blood Pressure and Cardiac Function in Patients Undergoing Maintenance Hemodialysis

Tang¹,

Zhu²,

Wang³

et al. 2019

Ther Apher Dial

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The effect of blood pump flow rate on the cardiac functions of hemodialysis patients with arteriovenous fistula (AVF) is largely unknown. This study aimed to investigate if blood pump flow rate (Qb) and AVF access flow rate (Qa) can affect the cardiac function of Chinese hemodialysis patients. A total of 72 patients undergoing AVF hemodialysis were included from March 2010 to June 2014 and dichotomized into the high‐ and low‐flow groups using the medians of Qb (220 mL/min) and Qa (1000 mL/min) as the cutoffs. The cardiac function parameters were measured by ultrasound dilution technique within the first (t + 30) and the last (t − 30) 30 min of dialysis. At t + 30, Qb‐high group had significantly higher systolic blood pressure (SBP) and mean arterial pressure (MAP) than Qb‐low group. At t − 30, Qb‐high group had higher SBP, diastolic blood pressure (DBP), and MAP than Qb‐low group. Qa‐high group had higher SBP, MAP, cardiac output (CO), cardiac index (CI), central blood volume (CBV), and lower peripheral resistance than Qa‐low group. Multiple linear regression showed that at t − 30, Qb was positively correlated with SBP and MAP. Qa was positively correlated with CO, CI, CBV, and PR but negatively correlated with heart rate. Although Qb > 220 mL/min and Qa >1000 mL/min would elevate some parameters, the means of SBP, DBP, MAP remain within the normal range, indicating that appropriate increase in blood pump flow rate has little effect on the cardiac function of hemodialysis patients.

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“…15 Frequently, high-output failure can result from a known arteriovenous fistula used for hemodialysis in patients end-stage renaldisease. 16,17 A case of renal cell carcinoma causing systemic arteriovenous shunting and highoutput cardiac failure has also been described. 18 Signs and symptoms of renal arteriovenous fistulae include an abdominal bruit (100%), hypertension and cardiomegaly (50%), congestive heart failure (32%), and gross hematuria (21%).…”

Section: Discussionmentioning

confidence: 99%

The Thrill Is Gone

2015

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Foreword Information about a real patient is presented in stages (boldface type) to expert clinicians (Drs Beckman and Sobieszczyk), who respond to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows.A n 85-year-old white woman with longstanding atrial fibrillation and hypertension presented to our emergency department with a 2-day history of progressive dyspnea. Earlier that week she had been seen by an outpatient provider and was found to be hypotensive. Her home bumetanide was discontinued, and she developed dyspnea that progressed after missing 2 doses. She reported that she was sleeping with more pillows and that she had a limited ability to walk and a new cough.Her recent history was notable for progressive fatigue and dyspnea over the past year. In the past 3 months she had been treated as an outpatient with loop diuretics for presumed congestive heart failure by a cardiologist. Her recent history was also notable for recurrent hematochezia requiring 5 admissions, including an intensive care unit admission for hemorrhagic shock, over the preceding 6 months. An extensive evaluation, including esophagastroduodenoscopy, several colonoscopies, and a small-intestine capsule study were unrevealing; she was noted only to have severe diverticulosis. During this period, her warfarin and, after additional bleeding episodes, her aspirin were stopped in light of her recurrent bleeding.Additional medical history included a diagnosis of cataracts, macular degeneration, and osteoarthritis. Medications included bumetanide 1 mg daily, metoprolol succinate 50 mg daily, omeprazole 40 mg daily, and calcium supplements. She had no known drug allergies.Dr Beckman: Dyspnea in an older patient is a common concern and is predominantly caused by a range of cardiopulmonary diseases. In this case, the patient's presentation is notable for progressive dyspnea over 1 year that has acutely worsened over several days. Her report of orthopnea, cough, and exertional intolerance suggest that an exacerbation of congestive heart failure is likely. Moreover, her diagnosis of congestive heart failure is only presumed, and further investigation is needed to understand this acute presentation. Other etiologies of progressive dyspnea include anemia related to her recent gastrointestinal bleeding, or a primary pulmonary process such as interstitial lung disease, chronic obstructive pulmonary disease, malignancy, pulmonary hypertension, or an infectious process such as a viral respiratory infection or pneumonia. Patient presentation (continued):Initial vital signs on presentation included an oral temperature of 95°F, a heart rate of 81 beats per minute, blood pressure of 110/56 mm Hg, respiratory rate of 20 breaths per minute, oxygen saturation of 85% on room air with improvement to 95% on 3 L nasal cannula oxygen supplementation. Physical examination was notable for a cachectic-appearing woman in no acute distress. Her neck examination revealed marked internal jugular venous engorgement with v...

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Incidence of arteriovenous fistula closure due to high‐output cardiac failure in kidney‐transplanted patients

Abstract: The necessity of shunt closure is not a rarity. Patients who underwent an AV fistula ligature had high access flows with about 2200 mL/min. As the symptoms of cardiac failure greatly improved after shunt closure, patients with high access flow may benefit from such an intervention.

Cited by 35 publications

References 16 publications

Arteriovenous Fistula After Kidney Transplantation in University Hospital Centre Osijek

Arteriovenous Fistula After Kidney Transplantation in University Hospital Centre Osijek

Effect of Blood Pump Flow and Arteriovenous Fistula Blood Flow on the Blood Pressure and Cardiac Function in Patients Undergoing Maintenance Hemodialysis

The Thrill Is Gone

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