Influence of intradialytic systolic blood pressure changes on arteriovenous access thrombosis in maintenance hemodialysis patients

Abstract

Background Arteriovenous access (AV) thrombosis is an important and preventable problem amongst chronic hemodialysis (HD) patients. Systolic blood pressure (SBP) fluctuation relates to higher cardiovascular mortality amongst these patients. We proposed there is a close relation between SBP changes and arteriovenous (AV) access thrombosis. We also determined other risk factors and biochemical parameters related to AV access failure. Methods 50 HD patients with thrombosis and 50 HD patients without thrombosis were included in the study. Odds ratios and 95% confidence intervals were estimated with multivariate‐adjusted logistic regression models to determine the association between potential thrombosis‐related risk factors and thrombosis risk. Results Elder adults, women, and patients with AV grafts, lower intradialytic SBP and higher SBP variations during HD sessions had higher incidence of AV access thrombosis. AV access infection and decreased blood flow (BF) velocity were associated with an increased incidence of thrombotic events, whereas the use of anti‐thrombotic agents was associated with a decreased incidence of thrombotic events. Further, anaemia, hypoalbuminemia, hyperlipidemia, and impaired mineral metabolism parameters were also found to be associated with AV access thrombosis. Conclusions Close monitoring and management of intradialytic hypotension and SBP fluctuation in every HD session are important. Some important and novel modifiable risk factors related to AV access thrombosis were identified in this study (eg, AV access infection, decreased BF and abnormal biochemical parameters, etc). Earlier surveillance and modification of these risk factors is crucial to prevent AV access failure in HD patients.

The association of long-term blood pressure variability with hemodialysis access thrombosis

“…For example, a secondary analysis of the Hemodialysis (HEMO) Study revealed frequent episodes of intradialytic hypotension associated with AV fistula thrombosis. Two recent retrospective studies also found that the variability of intradialytic BP can predict access thrombosis ( 13 , 14 ). Nonetheless, in most circumstances, access thrombosis occurred in the inter-dialytic period.…”

“…The effect of short-term BPV on the prognosis of hemodialysis patients has been reported. Intradialytic hypotension and intradialytic BP variability were associated with vascular access outcomes ( 6 , 13 , 14 ). Long-term BPV is reproducible over time but is only modestly related to short-term variability ( 15 , 16 ).…”