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

BACKGROUND: Satisfactory 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...

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Autores principales: Basile, Carlo, Vernaglione, Luigi, Casucci, Francesco, Libutti, Pasquale, Lisi, Piero, Rossi, Luigi, Vigo, Valentina, Lomonte, Carlo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036899/
https://www.ncbi.nlm.nih.gov/pubmed/27679720
http://dx.doi.org/10.1093/ckj/sfw063
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author Basile, Carlo
Vernaglione, Luigi
Casucci, Francesco
Libutti, Pasquale
Lisi, Piero
Rossi, Luigi
Vigo, Valentina
Lomonte, Carlo
author_facet Basile, Carlo
Vernaglione, Luigi
Casucci, Francesco
Libutti, Pasquale
Lisi, Piero
Rossi, Luigi
Vigo, Valentina
Lomonte, Carlo
author_sort Basile, Carlo
collection PubMed
description BACKGROUND: Satisfactory 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). METHODS: All 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·CO(2). The latter was computationally divided into the part spent to run Qa through the AVF (LLV(AVF)) 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. RESULTS: Mean Qa, CO, MAP, TPVR, LLV and LLV(AVF) 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 LLV(AVF) 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 (R(2) = 0.546; P < 0.0001) and for both lower (R(2) = 0.181; P < 0.01) and upper arm AVFs (R(2) = 0.663; P < 0.0001). LLV(AVF) 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 LLV(AVF) was statistically significantly higher in upper arm AVFs (P < 0.0001). CONCLUSIONS: Our 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 LLV(AVF) and Qa, but only in lower arm AVFs.
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spelling pubmed-50368992016-09-27 The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system Basile, Carlo Vernaglione, Luigi Casucci, Francesco Libutti, Pasquale Lisi, Piero Rossi, Luigi Vigo, Valentina Lomonte, Carlo Clin Kidney J Vascular Access BACKGROUND: Satisfactory 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). METHODS: All 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·CO(2). The latter was computationally divided into the part spent to run Qa through the AVF (LLV(AVF)) 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. RESULTS: Mean Qa, CO, MAP, TPVR, LLV and LLV(AVF) 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 LLV(AVF) 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 (R(2) = 0.546; P < 0.0001) and for both lower (R(2) = 0.181; P < 0.01) and upper arm AVFs (R(2) = 0.663; P < 0.0001). LLV(AVF) 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 LLV(AVF) was statistically significantly higher in upper arm AVFs (P < 0.0001). CONCLUSIONS: Our 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 LLV(AVF) and Qa, but only in lower arm AVFs. Oxford University Press 2016-10 2016-07-15 /pmc/articles/PMC5036899/ /pubmed/27679720 http://dx.doi.org/10.1093/ckj/sfw063 Text en © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Vascular Access
Basile, Carlo
Vernaglione, Luigi
Casucci, Francesco
Libutti, Pasquale
Lisi, Piero
Rossi, Luigi
Vigo, Valentina
Lomonte, Carlo
The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system
title The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system
title_full The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system
title_fullStr The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system
title_full_unstemmed The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system
title_short The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system
title_sort impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system
topic Vascular Access
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036899/
https://www.ncbi.nlm.nih.gov/pubmed/27679720
http://dx.doi.org/10.1093/ckj/sfw063
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