The effects of preoperative blood pressure on early failure rate of distal arteriovenous fistulas for hemodialysis access

Abstract

Introduction The first choice of vascular access for hemodialysis in patients with end‐stage renal disease is a distal radiocephalic arteriovenous fistula (AVF). Early failure rates for these AVFs vary from 10% to 53%. The effects of predialysis hypotension on failure of AVFs have been described in the literature. Weather lower blood pressures affect early AVF failure has not been extensively studied. We conducted this study to evaluate the effects of preoperative blood pressures on early AVF failure. Methods Ours was a prospective observational study over a period of 2 years that included 224 patients who underwent distal radiocephalic AVF creation. Only those patients were included whose fistulas were made by surgeons with an experience of greater than five cases. The systolic, diastolic, and mean arterial pressures (MAPs) were recorded preoperatively. Early failure was defined as failure to achieve vascular access from the fistula within first 4 months of its creation. Findings The overall early failure rate was 27.7%. Early failure was more common in females and diabetic patients. The systolic, diastolic, and MAPs were significantly lower in patients with early failure (P < 0.05). In a multivariable adjusted analysis, lower preoperative diastolic and MAPs were predictors for early failure of distal radiocephalic AVF. Discussion Our study shows that patients with early failure of AVFs have lower preoperative blood pressure. A larger study is required to substantiate our findings and define target preoperative blood pressure for AVF creation.

Contact Laxative Use and the Risk of Arteriovenous Fistula Maturation Failure in Patients Undergoing Hemodialysis: A Multi-Center Cohort Study

“…The association between contact laxative used and an increased risk of diarrhea was shown in a recent meta-analysis (risk ratio, 13.75; 95% CI, 2.82–67.14) compared with the placebo [ 27 ]. Diarrhea is often accompanied by dehydration and electrolyte loss, which may alter hemodynamics (hypotension) and potentially lead to AVF dysfunction/occlusion [ 28 , 29 ]. Second, contact laxatives may induce intestinal mucosal barrier injury and gut dysbiosis.…”

Predictors of Arteriovenous Fistula Failure: A Post Hoc Analysis of the FAVOURED Study

“…Earlier studies suggested that tight control of systolic, diastolic and/or mean arterial pressures pre-operatively was associated with increased odds of AVF thrombosis 36,37 and early primary AVF failure 38,39 . Pandey et al studied 224 patients prospectively and reported that patients with early AVF failure had lower diastolic blood pressure of 88.4 mmHg compared to 91.2mmHg in those with AVF success 39 . Similarly, a retrospective review of 1051 patients found patients with early primary failure had lower diastolic pressure of 79.7mmHg compared to 83.1mmHg in those with AVF success 38 .…”

Effectiveness of hydropathic compress of dandelion in ameliorating complications of arteriovenous fistula

“…Hemodialysis (HD) is the most common treatment for patients with end-stage renal disease (ESRD), accounting for 91.0 % of all dialysis patients [1]. Arteriovenous fistula (AVF) is the preferred vascular pathway for hemodialysis in ESRD patients [2]. Autologous arteriovenous fistulas provide sufficient blood flow for hemodialysis, with a long-term application, maintenance of blood flow, and few complications [3].…”