High-flow arteriovenous fistula and myocardial fibrosis in hemodialysis patients with non-contrast cardiac magnetic resonance imaging

Choi, Yong Seon; Lee, In Jae; An, Jung Nam; Song, Young Rim; Kim, Sung Gyun; Lee, Hyung Seok; Kim, Jwa-Kyung

doi:10.3389/fcvm.2022.922593

Cited by 3 publications

(3 citation statements)

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“…Also, HOHF is linked to higher mortality ( 30 ). High-flow AVFs have recently been associated with increased myocardial fibrosis ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Heart failure with preserved ejection fraction is the most frequent but commonly overlooked phenotype in patients on chronic hemodialysis

Malik,

Valerianova,

Pesickova

et al. 2023

Front. Cardiovasc. Med.

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IntroductionHeart failure (HF) is a serious complication of end-stage kidney disease (ESKD). However, most data come from retrospective studies that included patients on chronic hemodialysis at the time of its initiation. These patients are frequently overhydrated, which significantly influences the echocardiogram findings. The primary aim of this study was to analyze the prevalence of heart failure and its phenotypes. The secondary aims were (1) to describe the potential of N-terminal pro-brain natriuretic peptide (NTproBNP) for HF diagnosis in ESKD patients on hemodialysis, (2) to analyze the frequency of abnormal left ventricular geometry, and (3) to describe the differences between various HF phenotypes in this population.MethodsWe included all patients on chronic hemodialysis for at least 3 months from five hemodialysis units who were willing to participate, had no living kidney transplant donor, and had a life expectancy longer than 6 months at the time of inclusion. Detailed echocardiography together with hemodynamic calculations, dialysis arteriovenous fistula flow volume calculation, and basic lab analysis were performed in conditions of clinical stability. Excess of severe overhydration was excluded by clinical examination and by employing bioimpedance.ResultsA total of 214 patients aged 66.4 ± 14.6 years were included. HF was diagnosed in 57% of them. Among patients with HF, HF with preserved ejection fraction (HFpEF) was, by far, the most common phenotype and occurred in 35%, while HF with reduced ejection fraction (HFrEF) occurred only in 7%, HF with mildly reduced ejection fraction (HFmrEF) in 7%, and high-output HF in 9%. Patients with HFpEF differed from patients with no HF significantly in the following: they were older (62 ± 14 vs. 70 ± 14, p = 0.002) and had a higher left ventricular mass index [96(36) vs. 108(45), p = 0.015], higher left atrial index [33(12) vs. 44(16), p < 0.0001], and higher estimated central venous pressure [5(4) vs. 6(8), p = 0.004] and pulmonary artery systolic pressure [31(9) vs. 40(23), p = 0.006] but slightly lower tricuspid annular plane systolic excursion (TAPSE): 22 ± 5 vs. 24 ± 5, p = 0.04. NTproBNP had low sensitivity and specificity for diagnosing HF or HFpEF: with the use of the cutoff value of 8,296 ng/L, the sensitivity of HF diagnosis was only 52% while the specificity was 79%. However, NTproBNP levels were significantly related to echocardiographic variables, most significantly to the indexed left atrial volume (R = 0.56, p < 10−5) and to the estimated systolic pulmonary arterial pressure (R = 0.50, p < 10−5).ConclusionsHFpEF was by far the most common heart failure phenotype in patients on chronic hemodialysis and was followed by high-output HF. Patients suffering from HFpEF were older and had not only typical echocardiographic changes but also higher hydration that mirrored increased filling pressures of both ventricles than in those of patients without HF.

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“…Also, HOHF is linked to higher mortality ( 30 ). High-flow AVFs have recently been associated with increased myocardial fibrosis ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Heart failure with preserved ejection fraction is the most frequent but commonly overlooked phenotype in patients on chronic hemodialysis

Malik,

Valerianova,

Pesickova

et al. 2023

Front. Cardiovasc. Med.

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“…On the other hand, the establishment of AVF can lead to higher venous reflux with resultant high-output heart failure [ 11 , 12 ]. Choi’s team found that high-flow AVF was associated with an increased risk of myocardial fibrosis and heart failure in MHD patients [ 13 ]. Besides, it also affects pulmonary circulation and eventually induces pulmonary hypertension, which is another life-threatening complication for end-stage renal disease (ESRD) patients [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

An ultrasound-guided no incision banding method for the treatment of arteriovenous fistula high-flow in hemodialysis

Wang

Jin

Chen³

et al. 2023

Renal Failure

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Objective High-flow vascular access is one of the serious complications in the maturation and subsequent use of arteriovenous fistula (AVF). We adopted a novel surgical approach named no incision limited ligation indwelling needle assisted- revision (NILLINR) to treat high-flow of the hemodialysis vascular access and ascertained the outcomes by regular follow-up visits. Methods This is a retrospective study. 26 hemodialysis patients with symptomatic high-flow access (access flow > 1500 mL/min) were treated with the novel banding method without incision between June 2018 and October 2020. The flow of the brachial artery before and after the restriction was measured by experienced clinicians by using the duplex Doppler ultrasound (DUS). All 26 patients were followed up for up to 1 year. Meanwhile, the brachial artery flow was recorded at 6 months and 1 year after restriction. Results Of all 26 patients included in this study, the mean access flow volume decreased from 2196.2 ± 416.9 mL/min (mean ± SD) to 679.2 ± 67.1 mL/min immediately after the operation. During the follow-up, the volume flow of the brachial artery was still within the restricted range at 6 months (mean ± SD, 720.2 ± 164.7 mL/min) and 1 year (mean ± SD, 713.9 ± 173.8 mL/min) after the operation. Meanwhile, the mean duration of the operation is 8.5 ± 3.3 min, and there is no bleeding or rupture. Conclusion This novel no-incision limited ligation indwelling needle-assisted revision is a safe, effective, and time-saving option to treat high-flow access.

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“…Hemodialysis, a vital therapeutic intervention for individuals with end-stage renal disease (ESRD), relies on the establishment of an arteriovenous fistula (AVF) as the preferred vascular access [1]. While AVFs are highly valued for their longevity and reduced risk of infection, their impact on cardiac function in hemodialysis patients has drawn significant attention in recent years [2][3][4]. The creation of an AVF introduces profound hemodynamic changes in the cardiovascular system [5].…”

Section: Introductionmentioning

confidence: 99%

Hemodialysis Patients with High-Flow Arteriovenous Fistulas: An Evaluation of the Impact on Cardiac Function

Tayebi,

Ziaie,

Golshan

et al. 2024

Vasc Specialist Int

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Purpose: Patients undergoing hemodialysis often experience changes in cardiac function when they have a high-flow arteriovenous fistula (AVF). This study aimed to assess the effect of high-flow AVFs on cardiac function in patients undergoing hemodialysis. Materials and Methods:A longitudinal study was conducted on hemodialysis patients with high-flow AVFs. Echocardiographic parameters, such as left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), right ventricular end-diastolic dimension (RVEDD), inferior vena cava diameter (IVCD), systolic blood pressure, and diastolic blood pressure, were measured and compared before and after AVF creation. Results: One hundred hemodialysis patients with high-flow AVFs (mean age: 55.95±13.39 years, mean body mass index: 24.71±3.43 kg/m²) were studied. LVEF significantly decreased (51.10%±5.39% to 47.50%±5.79%), while LAD, LVEDD, and IVCD significantly increased after AVF creation (P<0.05). Systolic (132.49±16.42 mmHg to 146.60±17.43 mmHg) and diastolic (79.98±8.40 mmHg to 83.33±9.68 mmHg) blood pressure substantially rose post-fistularization (P<0.001). Notably, LVEF reduction was more significant in brachio-cephalic AVFs (46.29%±4.24%) compared to distal radio-cephalic or snuffbox AVFs (49.17%±7.15%) (P=0.014). Conclusion: High-flow AVFs can significantly affect echocardiographic parameters in hemodialysis patients, thereby increasing the risk of cardiac failure. Close cardiac monitoring may be necessary for early intervention. Distal AVFs may be preferable in patients with decreased cardiac function.

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High-flow arteriovenous fistula and myocardial fibrosis in hemodialysis patients with non-contrast cardiac magnetic resonance imaging

Cited by 3 publications

References 34 publications

Heart failure with preserved ejection fraction is the most frequent but commonly overlooked phenotype in patients on chronic hemodialysis

Heart failure with preserved ejection fraction is the most frequent but commonly overlooked phenotype in patients on chronic hemodialysis

An ultrasound-guided no incision banding method for the treatment of arteriovenous fistula high-flow in hemodialysis

Hemodialysis Patients with High-Flow Arteriovenous Fistulas: An Evaluation of the Impact on Cardiac Function

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