Are high flow arteriovenous accesses associated with worse haemodialysis?

Laranjinha, Ivo; Matias, Patrícia; Azevedo, Ana; Navarro, David; Ferreira, Carina; Amaral, Tiago; Mendes, Marco; Aires, Inês; Jorge, Cristina; Gil, Célia; Ferreira, A. J. A.

doi:10.1590/2175-8239-jbn-3875

Cited by 3 publications

(3 citation statements)

References 28 publications

(40 reference statements)

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“…Only 6.3% (13 of 205) of our patients had high-flow AVF (≥1,500 mL/min); however, this proportion ranged from 14% to 24% in other studies [11,26,27]. There are currently no universally accepted criteria to define HF-AVF; however, thresholds of 1,500 mL/min [28] and 2,000 mL/min [29] were often cited and were found to correlate with adverse cardiac remodeling. Tang et al [30] reported that a Qa tertile of >1,027.13 mL/min was associated with a higher risk of CVD in Chinese individuals.…”

Section: Discussionmentioning

confidence: 65%

Hemodynamic factors affecting pulmonary hypertension in hemodialysis patients

Zhang,

Xiao,

et al. 2023

Kidney Res Clin Pract

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Background:The fluid status and rate of blood flow through the arteriovenous fistula (AVF) are two important factors affecting hemodynamic in hemodialysis patients; however, their effects on pulmonary hypertension have rarely been studied. Hence, we aimed to evaluate the effects of these factors in hemodialysis patients with pulmonary hypertension. Methods: This single-center cross-sectional survey included 219 maintenance hemodialysis patients (139 [63.5%] male). The prevalence of pulmonary hypertension was 13.6% (30 of 219). Pulmonary artery pressure was measured by echocardiography, fluid status was measured objectively using bioimpedance spectroscopy, and blood flow rate in the AVF (Qa) was determined using Doppler ultrasound.Results: The overall mean overhydration before hemodialysis was 1.5 L (range, 0.6-2.8 L). The mean overhydration in patients with and without pulmonary hypertension was 3.6 L (range, 2.3-4.6 L) and 1.4 L (range, 0.6-2.4 L), respectively (p < 0.001). The overall mean Qa was 780 mL/min (range, 570-1,015.5 mL/min). The mean Qa of patients with and without pulmonary hypertension was 672 mL/min (range, 505.7-982.2 mL/min) and 790 mL/min (range, 591-1,026 mL/min), respectively (p = 0.27). Overhydration (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.08-1.97; p = 0.01), N-terminal prohormone of brain natriuretic peptide (NT-proB-NP; OR, 1.36; 95% CI, 1.09-1.71; p = 0.007), and left atrial diameter (OR, 1.14; 95% CI, 1.01-1.28; p = 0.03) were risk factors. Conclusion: Pulmonary hypertension is strongly associated with overhydration, NT-proBNP, and left atrial diameter in hemodialysis patients.

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Section: Discussionmentioning

confidence: 65%

Hemodynamic factors affecting pulmonary hypertension in hemodialysis patients

Zhang,

Xiao,

et al. 2023

Kidney Res Clin Pract

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“…Therefore, it is conceivable that high flow fistulas can be associated with volume overload. Their study1 revealed that severe volume overload was more prevalent in high flow fistulas (n = 4) when compared to normal flow fistulas (n = 6). Multivariate analysis demonstrated an odds ratio of 4.06 and a confidence interval of 1.01-16.39 with a p value of 0.056.…”

mentioning

confidence: 97%

“…In their article entitled, "Are high flow arteriovenous accesses associated with worse haemodialysis"1 the authors investigated a cohort of 304 hemodialysis patients. Of these, 48 patients demonstrated high flow.…”

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confidence: 99%

High Flow and volume overload: The saga continues

Cheng

Costanzo²,

Vachharajani

et al. 2018

J. Bras. Nefrol.

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High-flow arteriovenous fistula is not associated with increased extracellular volume or right ventricular dysfunction in haemodialysis patients

Jaques

Davenport

2020

Nephrology Dialysis Transplantation

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Background High-output congestive heart failure secondary to high-flow arteriovenous fistula (AVF) has been reported in haemodialysis (HD) patients. As high-flow AVF (HFA) would be expected to result in fluid retention, we conducted an observational study to characterize the relationship between AVF flow (Qa) and extracellular water (ECW) in HD patients. Methods We measured Qa by ultrasound dilution in prevalent HD outpatients with an AVF in two dialysis centres. The ECW:total body water (TBW) ratio was measured both pre- and post-dialysis by multifrequency bioimpedance analysis. Transthoracic echocardiograms (TTEs) were performed as part of routine clinical management. Results We included 140 patients, mean age 62.7 ± 15.7 years, 60.7% male, 47.9% diabetic and 22.9% with coronary revascularization. Mean Qa was 1339 ± 761 mL/min and 22 (15.7%) patients had HFA defined as Qa >2.0 L/min. Qa was positively associated with an upper arm AVF (P = 0.005), body mass index (P = 0.012) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (P = 0.047) and negatively associated with diabetes (P < 0.001) and coronary revascularization (P = 0.005). The ECW:TBW ratio was positively associated with age (P < 0.001), Davies comorbidity index (P = 0.034), peripheral vascular disease (P = 0.030) and NT-proBNP (P = 0.002) and negatively associated with serum albumin (P < 0.001). Qa was not associated with the ECW:TBW ratio (P = 0.744). TTE parameters were not associated with Qa. Conclusions In our outpatient HD cohort, high AVF flow was not associated with ECW expansion, either pre- or post-dialysis when accounting for potential confounders. By controlling ECW, high access flow should not necessarily be perceived as a threat to cardiovascular physiology.

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Are high flow arteriovenous accesses associated with worse haemodialysis?

Cited by 3 publications

References 28 publications

Hemodynamic factors affecting pulmonary hypertension in hemodialysis patients

Hemodynamic factors affecting pulmonary hypertension in hemodialysis patients

High Flow and volume overload: The saga continues

High-flow arteriovenous fistula is not associated with increased extracellular volume or right ventricular dysfunction in haemodialysis patients

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