The Relation Between Vascular Access Flow and Different Types of Vascular Access With Systemic Hemodynamics in Hemodialysis Patients

Abstract

Access flow (Qa) has an important effect on systemic hemodynamics in dialysis patients. A Qa : cardiac output (CO) ratio higher than 0.3 is considered a risk factor for high-output cardiac failure. However, the effect of different types of vascular access in hemodialysis patients has not yet been studied. The aim of the present study was to assess the relationship between Qa and systemic hemodynamics and to compare systemic hemodynamics between patients with elbow/upperarm access with forearm access types. Qa, CO, cardiac index (CI), central blood volume (CBV), and peripheral vascular resistance (PVR) were studied by the saline dilution technique in 58 hemodialysis patients (18 with elbow/upperarm access; 40 with forearm access types). This article found that Qa was significantly and positively related to CO and CI, and inversely related to PVR. CBV, Qa, and presence of cardiac failure were independent determinants of CI. Qa and the Qa : CO ratio were significantly higher, and PVR significantly lower, in patients with elbow/upperarm access compared to patients with forearm access types. When patients with cardiac failure were excluded, CO and CI were also significantly higher in patients with elbow/upperarm access types. Eleven percent of patients with elbow/upperarm fistula had a Qa : CO ratio above 0.3. In conclusion, Qa is strongly related to systemic hemodynamics in dialysis patients. In patients without cardiac failure, CO and CI are significantly higher in patients with elbow/upperarm access compared to patients with forearm access types. However, only a small percentage of patients with elbow/upperarm fistulae appeared to be in the risk zone for development of high-output cardiac failure.

High-output heart failure due to subclavian vessel fistula as a late complication following implantation of a biventricular pacemaker

“…In these patients, central upper arm AVF were associated with almost 2-fold higher flow rates compared with peripheral forearm fistulas 3 . As a consequence, invasive hemodynamic measurement revealed increased cardiac output in patients with upper arm fistulas 3 …”

Validation of a patient-specific hemodynamic computational model for surgical planning of vascular access in hemodialysis patients

“…10 Currently, the choice of location and type of the anastomosis is based, beyond evaluation of systemic factors, on blood vessel diameter only, following the indication that radial arteries o2 mm will probably result in AVF failure (NKF K-DOQI Guidelines), and considering that distal VA more likely results in lower BFV and in a high incidence of early nonfunction, 11 whereas proximal VA more likely results in very high BFV, increasing the risk of steal syndrome and cardiac failure. 12,13 However, BFV enhancement following VA creation is influenced by the combination of geometrical factors (for example, vascular diameters and lengths along the arterial tree), vessel topology (for example, number and size of venous side branches), peripheral resistance, type of anastomosis, and vessel adaptation. An objective and reliable prediction of postoperative increase in BFV over time could be extremely relevant for planning the optimal AVF configuration, and may reduce the incidence of VA dysfunctions.…”

Type of arteriovenous fistula, NYHA class and apelin in hemodialyzed patients

“…Patients with severe heart failure, NYHA class IV, due to intrinsic heart disease, are at considerable risk of worsening cardiac function after the creation of an arteriovenous dialysis access. This risk is greater for an upper arm fistula than with one located in the forearm [11,12]. Although in our previous study, we excluded patients with clinically overt CHF (NYHA III/IV), apelin levels were lower than reported for patients with CHF in other studies [13].…”