Acute arterio-venous fistula occlusion decreases sympathetic activity and improves baroreflex control in kidney transplanted patients

Velez‐Roa, Sonia; Neubauer, Jolanta; Wissing, Martin; Porta, Alberto; Somers, Virend K.; Unger, Philippe; Borne, Philippe van de

doi:10.1093/ndt/gfh124

Cited by 28 publications

(18 citation statements)

References 14 publications

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“…Fistula flow was estimated through the decrease in CO produced by compression of the AVF. Indeed, previous observations have shown that this decrease correlates with fistula flow (14), and this parameter has been used as a substitute for direct fistula flow measurement (6,15,16). The AVF was occluded at the end of the initial echocardiographic study by inflating a sphygmomanometer cuff to a 50 mmHg suprasystolic pressure for 30 s (6).…”

Section: Methodsmentioning

confidence: 99%

Regression of Left Ventricular Hypertrophy After Arteriovenous Fistula Closure in Renal Transplant Recipients: A Long-Term Follow-Up

Unger¹,

Velez‐Roa²,

Wissing

et al. 2004

American Journal of Transplantation

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The long-term effects of hemodialysis arteriovenous fistula (AVF) closure on left ventricular (LV) morphology are unknown. Using echocardiography, we prospectively studied 17 kidney transplant recipients before, 1, and, 21 months after AVF closure (mean fistula flow 1371 ± 727 mL/min). Eight kidney transplant recipients with a patent AVF, matched for age, time after AVF creation, and time after transplantation, served as controls. LV mass index (LVMI) decreased from 139 ± 44 g/m 2 before AVF closure to 127 ± 45 g/m 2 and 117 ± 40 g/m 2 at 1 and 21 months post-closure, respectively (p < 0.001), but remained unchanged in controls. LV hypertrophy prevalence (LVMI > 125 g/m 2 ) decreased from 65% before, to 41% early, and 18%, late, after surgery (p = 0.008), mostly from a decrease in LV end-diastolic diameter. Consequently, the prevalence of LV concentric remodeling (relative wall thickness > 0.45 without hypertrophy) increased from 12% before, to 35% early, and 65% late, after surgery (p = 0.003). Diastolic arterial blood pressure increased from 78 ± 15 mmHg before, to 85 ± 13 mmHg early, and 85 ± 10 mmHg late, after surgery (p < 0.015).In conclusion, closure of large and/or symptomatic AVF induces longterm regression of LV hypertrophy. However, residual concentric remodeling geometry as well as diastolic blood pressure increase may blunt the expected beneficial cardiac effects of the procedure.

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Section: Methodsmentioning

confidence: 99%

Regression of Left Ventricular Hypertrophy After Arteriovenous Fistula Closure in Renal Transplant Recipients: A Long-Term Follow-Up

Unger¹,

Velez‐Roa²,

Wissing

et al. 2004

American Journal of Transplantation

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“…The hemodynamic significance of an AVF could be determined by studying the hemodynamic differences induced by acute AVF occlusion [15]. Therefore, we decided to evaluate the changes in hemodynamic and microcirculatory blood flow after acute occlusion of the fistula.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we decided to evaluate the changes in hemodynamic and microcirculatory blood flow after acute occlusion of the fistula. In humans with an AVF, the hemodynamic dif ferences after temporary compression of the fistula are called the Nicoladoni or Branham sign, which consists of a decrease in HR, an increase in blood pressure, and a reduction in pulse pressure [2, 15]. In the current study, SBP and DBP increased significantly after acute occlusion of the fistula; some hemodynamic mechanisms might contribute to these effects, such as a sudden increase in systemic vascular resistance and a decrease in cardiac venous return after occlusion of the AVF [15].…”

Section: Discussionmentioning

confidence: 99%

“…Third, the surgical advantages of the neck region are its good perfusion and cleanness, as well as the avoidance of laparotomy, as in aortocaval fistulae (ACF). We assumed that more information about the microcirculatory status will be available from studying the microcirculatory changes after acute occlusion of the arterial limb of the fistula, since acute occlusion of the AVF leads to significant hemodynamic changes [15]. …”

Section: Introductionmentioning

confidence: 99%

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Carotid-Jugular Fistula Model to Study Systemic Effects and Fistula-Related Microcirculatory Changes

et al. 2018

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Background: Arteriovenous fistulae impair the distal circulation, but their effects at the microcirculatory level are not well understood. This study presents the carotid-jugular fistula (CJF) as a model to evaluate fistula-related microcirculatory and systemic changes. Materials and Methods: Female Wistar rats were anesthetized and divided into a fistula group (FG, n = 10) and a sham group (SG, n = 6). End-to-end anastomosis was performed between the right carotid artery and the jugular vein in the FG. The hemodynamic status was followed for 6 weeks. On the sixth postoperative week, liver and kidney microcirculation was measured using laser Doppler; then microcirculatory changes were assessed after occlusion of the carotid artery. At the end of the experiment, histological samples were taken and the weights of the organs were measured. Results: The heart rate and systolic blood pressure decreased significantly due to the CJF. Laser Doppler showed a reduction in liver blood flow units (BFU) in the FG in comparison with the SG (p = 0.01), and they increased (p < 0.01) after occlusion of the fistula. Kidney BFU showed slight changes only. The comparative morphological study revealed significant increases in heart weight (p < 0.001) and left ventricular hypertrophy (p = 0.008) in the FG. Conclusion: Beside hemodynamic and morphologic changes, a CJF causes a deterioration in the microcirculation of the liver rather than of the kidney, but occlusion of the CJF immediately reverses these changes.

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“…In small physiologic studies, acute occlusion of stable AV fistulas used for HD increased baroreceptor sensitivity to a greater degree than did carotid sinus massage 5 . Further vagal-mediated bradycardia from AV fistula occlusion may also be mitigated with atropine 3 or possibly with increased venous return achieved by lifting the lower extremities when the subject is in a supine position.…”

Section: Discussionmentioning

confidence: 99%

Persistent sinus node suppression caused by thrombotic occlusion of an arteriovenous fistula: A report of two cases

Huang

Waks

Josephson

et al. 2015

HeartRhythm Case Reports

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Acute arterio-venous fistula occlusion decreases sympathetic activity and improves baroreflex control in kidney transplanted patients

Abstract: Arterial baroreceptor activation and increased arterial baroreflex sensitivity decrease heart rate during AVF occlusion. In addition, our study is the first to demonstrate that arterial baroreflex activation decreases sympathetic nerve traffic during the Nicoladoni-Branham sign.

Cited by 28 publications

References 14 publications

Regression of Left Ventricular Hypertrophy After Arteriovenous Fistula Closure in Renal Transplant Recipients: A Long-Term Follow-Up

Regression of Left Ventricular Hypertrophy After Arteriovenous Fistula Closure in Renal Transplant Recipients: A Long-Term Follow-Up

Carotid-Jugular Fistula Model to Study Systemic Effects and Fistula-Related Microcirculatory Changes

Persistent sinus node suppression caused by thrombotic occlusion of an arteriovenous fistula: A report of two cases

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