Haemodialysis arteriovenous access - A prospective haemodynamic evaluation

Y. Ori, A. Korzets, M. Katz, Y. Perek, I. Zahavi, U. Gafter*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Factors affecting cardiac function in dialysis patients include arterial blood pressure, anaemia, intravascular volume, and the arteriovenous (a-v) access. Cardiac failure has been directly attributed to dialysis a-v access in several cases. The contribution of the a-v access to cardiac performance has been tested, in the past, by a short manual compression on the fistula, but this technique has obvious limitations. Methods. The present study examined prospectively the effect of dialysis a-v access on both cardiac function and various hormonal responses. Ten patients (age, mean ± SD, 59.6 ± 12.3) with end-stage renal failure being prepared for chronic dialysis therapy were included. All patients underwent an echocardiographic study before and 2 weeks after the creation of the a-v access. Plasma atrial natriuretic peptide (ANP), plasma renin activity (PRA), and plasma aldosterone were measured at the same time periods. Results. Following the creation of the a-v fistula or graft, shortening fraction increased by 15.8 ± 6.3% (P < 0.01), stroke volume increased by 21.9 ± 5.3% (P < 0.01), ejection fraction increased by 10.6 ± 4.5% (P < 0.02), cardiac output increased by 19.0 ± 6.9% (P < 0.02), and cardiac index increased by 18.3 ± 7.1% (P = 0.05). Systemic vascular resistance decreased by 23.5 ± 7.1% (P < 0.01). There was no change in blood pressure, heart rate, weight, haemoglobin or serum creatinine. ANP increased by 83.7 ± 17.0% following the a-v access operation (P < 0.001), PRA decreased by 41.2 ± 10.0% (P < 0.05), and plasma aldosterone did not change. None of the patients developed overt high-output cardiac failure. Conclusions. This study shows that at least in the short term following the creation of a dialysis a-v access, a mild state of volume overload develops, which is offset by the 'unloading' effect of the decreased peripheral vascular resistance; the latter is probably mediated by secretion of ANP in response to atrial stretching.

Original languageEnglish
Pages (from-to)94-97
Number of pages4
JournalNephrology Dialysis Transplantation
Volume11
Issue number1
DOIs
StatePublished - Jan 1996
Externally publishedYes

Keywords

  • Arteriovenous access
  • Atrial natriuretic peptide
  • Cardiac function
  • Cardiac output
  • Fistula
  • Haemodialysis

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