Effects of Arteriovenous Fistula on Blood Pressure in Patients With End‐Stage Renal Disease: A Systematic Meta‐Analysis

Abstract

Background Central arteriovenous fistula ( AVF ) creation is under investigation for treatment of severe hypertension. We evaluated the effects of AVF for initiation of hemodialysis on systolic, diastolic, and mean arterial blood pressure in patients with end‐stage renal disease. Methods and Results Data search included PubMed, Web of Science, and the Cochrane Library. A systematic review and meta‐analysis of peer‐reviewed studies reporting the effects of the creation/ligation of an AVF on blood pressure in patients with end‐stage renal disease was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analysis), PRISMA ‐P (PRISMA for systematic review protocols), and ROBINS‐I (Risk of Bias in Non‐Randomized Studies) criteria by the Cochrane Bias Methods Group. All studies in which the results could have been biased by hemodialysis were excluded. A total of 14 trials including 412 patients with end‐stage renal disease ( AVF creation, n=185; AVF ligation, n=227) fulfilled the criteria and were subsequently analyzed. Average blood pressure in patients with no/closed AVF was 140.5/77.6 mm Hg with a mean arterial blood pressure of 96.1 mm Hg. Following creation of AVF , systolic blood pressure significantly decreased by 8.7 mm Hg ( P <0.001), diastolic blood pressure by 5.9 mm Hg ( P <0.001), and mean arterial blood pressure by 6.6 mm Hg ( P =0.02), whereas after ligation systolic blood pressure increased by 5.2 mm Hg ( P =0.07), diastolic blood pressure by 3.8 mm Hg ( P =0.02), and mean arterial blood pressure by 3.7 mm Hg ( P =0.07) during short‐ to long‐term follow‐up. Conclusions Creation of AVF significantly decreases blood pressure in patients with end‐stage renal disease, whereas blood pressure tends to increase after ligation. These findings illustrate the hemodynamic consequences of AVF which are under investigation for severe hypertension.

Arteriovenous Fistula Creation and Estimated Glomerular Filtration Rate Decline in Advanced CKD: A Matched Cohort Study

“…In patient with AVF, vasodilatation in the contralateral arm through non-endothelial pathways has been described 24 , suggesting a systemic vasodilatory effect of AVF creation. In this regard, a recent meta-analysis shows a significant reduction of BP following AVF creation in ESKD patients 25 . AVF may also alter kidney function through hemodynamics effects, as an AVF is considered a high flow, low-resistance and highcompliance compartment added to the cardiovascular system 26 .…”

Determinants of Increased Central Excess Pressure in Dialysis: Role of Dialysis Modality and Arteriovenous Fistula

“…30 In a recent meta-analysis, it was shown that creation of dialysis AVF reduced SBP, DBP and MBP by estimated average of 8.7, 5.9 and 6.6-mm Hg respectively. 31 This observation is also in line with the use of ROX arteriovenous coupler, which is used to create an AVF between distal external iliac vein and artery, and which has been shown to reduce the ambulatory SBP by an average of 13.5 mm Hg in a group of patients with resistant hypertension 32 . Indeed, epidemiological observational studies using administrative databases show that hemodialysis with an AVF gives a better survival advantage over the use of central venous catheters.…”

Decrease in hand and cerebral oxygenation after percutaneous transluminal angioplasty for arteriovenous fistula stenosis in a patient on chronic hemodialysis

“…However, AVF creation was reportedly associated with hemodynamic changes because of the reduced peripheral resistance [12] , and increased right ventricular preload and left ventricular afterload [13] . In addition, AVF creation also significantly decreased blood pressure in end-stage renal disease [14] . Based on these reports, the increase in AVF blood flow in acute response to PTA procedure might lead to hemodynamic instability of the systemic circulation, and systemic oxygenation, including that within the brain, is likely to decrease because of the decrease in oxygen supply to the systemic tissues.…”