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The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system

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Razionale

Aim of the present study was to further our understanding of haemodynamic modifications of the cardiovascular system of haemodialysis (HD) patients associated to an arteriovenous fistula (AVF). Main objective was to calculate using real data in what way an AVF influences the load of the left ventricle (LLV).

Casistica e Metodi

All HD patients treated in our Dialysis Unit and bearing an AVF were enrolled into the present observational cross-sectional study. Fifty-six patients bore a lower arm AVF and 30 an upper arm AVF. Blood flow rate (Qa) and cardiac output (CO) were measured by means of the ultrasound dilution Transonic Hemodialysis Monitor HD02. Mean arterial pressure (MAP) was calculated; total peripheral vascular resistance (TPVR) was calculated as MAP/CO; LLV was calculated on the principle of a simple physical model: LLV (watt) = TPVR∙CO2. The data of the 86 AVFs were analyzed by categorizing them into lower and upper arm AVFs.

Risultati

Mean Qa, CO, MAP, TPVR and LLV of the 86 AVFs were respectively 1.3(0.6 SD) l/min, 6.3(1.3) l/min, 92.7(13.9) mmHg, 14.9(3.9) mmHg∙min/l and 1.3(0.6) watt. A statistically significant increase of Qa, CO and LLV and a statistically significant decrease of TPVR of upper arm AVFs compared to lower arm AVFs were shown. A third-order polynomial regression model best fitted the relationship between Qa and LLV for the entire cohort (R2 0.546; p < 0.0001) and for both lower (R2 0.181; p <0.01) and upper arm AVFs (R2 0.663; p <0.0001)(Figure).

Conclusioni

Our study describes using real data statistically significant haemodynamic modifications of the cardiovascular system of HD patients associated to an AVF and shows for the first time that the relationship between Qa and LLV is complex and a third-order polynomial regression model best fits this relationship.

Basile C.(1), Vernaglione L.(2), Casucci F.(3), Libutti P.(3), Lisi P.(3), Rossi L.(3), Vigo V.(4), Lomonte C.(3)
((1)Sezione di Ricerca Clinica, Divisione di Nefrologia, Ospedale Miulli, Acquaviva delle Fonti, (2)Divisione di Nefrologia, Ospedale Perrino, Brindisi, (3)Dvisione di Nefrologia, Ospedale Miulli, Acquaviva delle Fonti, (4)Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa)
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