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Haemodialysis arteriovenous access--a prospective haemodynamic evaluation
Summary
Dialysis arteriovenous access improves cardiac function by increasing cardiac output and decreasing vascular resistance. This leads to a mild volume overload, counteracted by atrial natriuretic peptide release.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- Cardiac function in dialysis patients is influenced by blood pressure, anemia, volume status, and arteriovenous (a-v) access.
- Arteriovenous access has been implicated in cardiac failure, but its precise impact on cardiac performance requires further investigation.
- Previous methods to assess a-v access impact on cardiac function, like manual compression, had limitations.
Purpose of the Study:
- To prospectively evaluate the short-term effects of dialysis a-v access creation on cardiac function.
- To assess the influence of a-v access on hormonal responses, including atrial natriuretic peptide (ANP), plasma renin activity (PRA), and aldosterone.
- To investigate the relationship between a-v access, cardiac performance, and hormonal changes in patients with end-stage renal failure.
Main Methods:
- Ten patients with end-stage renal failure underwent echocardiography before and two weeks after a-v access creation.
- Measurements included cardiac function parameters (shortening fraction, stroke volume, ejection fraction, cardiac output, cardiac index) and systemic vascular resistance.
- Plasma levels of ANP, PRA, and aldosterone were measured at the same time points.
Main Results:
- A-v access creation led to significant increases in shortening fraction (15.8%), stroke volume (21.9%), ejection fraction (10.6%), cardiac output (19.0%), and cardiac index (18.3%).
- Systemic vascular resistance decreased significantly (23.5%), while blood pressure, heart rate, and creatinine remained unchanged.
- ANP levels increased significantly (83.7%), PRA decreased (41.2%), and aldosterone levels did not change. No patients developed high-output cardiac failure.
Conclusions:
- Dialysis a-v access creation induces a short-term state of mild volume overload.
- This volume overload is effectively managed by a decrease in peripheral vascular resistance, likely mediated by ANP secretion.
- The findings suggest that a-v access positively impacts cardiac function in the short term, with hormonal regulation playing a key role.