Hemodialysis access type is associated with blood pressure variability and echocardiographic changes in end-stage...

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Vascular Access

Background:

• Arteriovenous fistula (AVF) is a recommended vascular access strategy for hemodialysis, associated with survival benefits.
• The precise mechanisms underlying AVF's survival advantage, particularly concerning blood pressure variability (BPV) and cardiac remodeling, require further elucidation.
• Understanding these mechanisms is crucial for optimizing hemodialysis patient outcomes and adherence to clinical guidelines.

Purpose of the Study:

• To investigate the association between AVF use and blood pressure variability (BPV) in hemodialysis patients.
• To explore the impact of AVF on cardiac structure and function, including left ventricular (LV) hypertrophy and ejection fraction (LVEF).
• To assess the long-term clinical outcomes, such as cardiovascular events and infections, associated with AVF versus other vascular access methods.

Main Methods:

• Retrospective cohort study of 611 hemodialysis patients from January 1, 2014, to December 31, 2014.
• Collection of baseline patient characteristics, dialysis parameters, and 1-year blood pressure records.
• Assessment of echocardiographic changes and clinical outcomes over a median 59-month follow-up period.

Main Results:

• AVFs were significantly associated with lower long-term systolic blood pressure (SBP) standard deviation (SD), lower long-term SBP residual metric, and lower intradialytic SBP residual.
• While not statistically significant, AVFs showed a trend towards higher rates of new left ventricular (LV) hypertrophy and increased LV volume, but a lower rate of new left ventricular ejection fraction (LVEF) dysfunction.
• Compared to catheters, AVFs were associated with a higher risk of cardiovascular events, all-cause infection, and access-related infection, though these benefits were primarily retained in the low-albumin subgroup.

Conclusions:

• AVFs are linked to improved blood pressure control, specifically reduced BPV, which may contribute to survival benefits in hemodialysis patients.
• The study suggests that BPV and other patient-specific factors play a role in the observed survival advantages of AVFs.
• Further research is warranted to fully understand the interplay between vascular access type, BPV, cardiac remodeling, and long-term outcomes in hemodialysis.