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

  • Ruoxi Liao
  • Liya Wang
  • Jiameng Li
  • Liping Lin
  • Si Sun
  • Yunqin Xiong
  • Yupei Li
  • Mei Han
  • Baihai SuEmail author
Original Article
  • 34 Downloads

Abstract

Arteriovenous fistula (AVF) strategy has been recommended in clinical guidelines for a long time due to the survival benefits associated with it. However, the underlying mechanism still needs to be explored. This retrospective cohort study included 611 patients who received hemodialysis in West China Hospital Medical Center between January 1, 2014 and December 31, 2014. Patient characteristics, dialysis parameters, and 1-year blood pressure records were collected at baseline. Echocardiographic changes and clinical outcomes were assessed during the 59-month follow-up. Our study showed that fistulas were associated with lower long-term systolic blood pressure (SBP) standard deviation (SD) (P < 0.0001), lower long-term SBP residual metric (P < 0.0001), and lower intradialytic SBP residual (P = 0.001). Fistulas were also associated with a higher but non-significant proportion of the newly developed left ventricular (LV) hypertrophy (8.29% vs. 6.78%, P = 0.116) and increased LV volume (8.29% vs. 4.52%, P = 0.139), as well as a lower proportion of the newly developed left ventricular ejection fraction (LVEF) dysfunction (1.62% vs. 2.82%, P = 0.586). After a median of 59-month follow-up, catheter group showed a higher risk of cardiovascular events (hazard ratio [HR] 1.21; 95% confidence interval [95%CI] 1.01–1.52), all-cause infection (HR 1.25; 95%CI 1.07–1.47), and access-related infection (HR 2.88; 95%CI 1.76–4.68). However, the advantage of fistulas only retained in low-albumin subgroup (serum albumin < 40 g/l) except for access-related infections. Our results suggested the possible attribution of BPV and other patient factors to fistula-associated survival benefits.

Keywords

Hemodialysis Vascular access Blood pressure Echocardiography Prognosis 

Notes

Acknowledgements

We gratefully acknowledge all the clinicians, statisticians, and laboratory technicians who contributed to this study.

Funding

This work was financially sponsored by the National Natural Science Foundation of China (Grant no. 51433007-1), the State Key Research Development Program of China (Grant no. 2016YFC1103004), and the Key Project of Research and Development of Science and Technology Department of Sichuan Province (Grant no. 2018FZ0102).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Supplementary material

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Supplementary material 1 (DOCX 14 KB)
40620_2018_574_MOESM2_ESM.pdf (199 kb)
Supplementary material 2 (PDF 198 KB)

References

  1. 1.
    Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, Zhao MH, Lv J, Garg AX, Knight J, Rodgers A, Gallagher M, Kotwal S, Cass A, Perkovic V (2015) Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 385(9981):1975–1982CrossRefGoogle Scholar
  2. 2.
    Thomas B, Wulf S, Bikbov B, Perico N, Cortinovis M, Courville DVK, Flaxman A, Peterson H, Delossantos A, Haring D, Mehrotra R, Himmelfarb J, Remuzzi G, Murray C, Naghavi M (2015) Maintenance dialysis throughout the World in Years 1990 and 2010. J Am Soc Nephrol 26(11):2621–2633CrossRefGoogle Scholar
  3. 3.
    Almasri J, Alsawas M, Mainou M, Mustafa RA, Wang Z, Woo K, Cull DL, Murad MH (2016) Outcomes of vascular access for hemodialysis: a systematic review and meta-analysis. J Vasc Surg 64(1):236–243CrossRefGoogle Scholar
  4. 4.
    Ravani P, Quinn R, Oliver M, Robinson B, Pisoni R, Pannu N, MacRae J, Manns B, Hemmelgarn B, James M, Tonelli M, Gillespie B (2017) Examining the association between hemodialysis access type and mortality: the role of access complications. Clin J Am Soc Nephrol 12(6):955–964CrossRefGoogle Scholar
  5. 5.
    Soleymanian T, Sheikh V, Tareh F, Argani H, Ossareh S (2018) Hemodialysis vascular access and clinical outcomes: an observational multicenter study. J Vasc Access 18(1):35–42CrossRefGoogle Scholar
  6. 6.
    Lomonte C, Forneris G, Gallieni M, Tazza L, Meola M, Lodi M, Senatore M, Morale W, Spina M, Napoli M, Bonucchi D, Galli F (2016) The vascular access in the elderly: a position statement of the vascular access working group of the Italian Society of Nephrology. J Nephrol 29(2):175–184CrossRefGoogle Scholar
  7. 7.
    Pisoni RL, Zepel L, Port FK, Robinson BM (2015) Trends in US vascular access use, patient preferences, and related practices: an update From the US DOPPS practice monitor with international comparisons. Am J Kidney Dis 65(6):905–915CrossRefGoogle Scholar
  8. 8.
    Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, Kosa SD, Quinn RR, Moist LM (2014) Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis 63(3):464–478CrossRefGoogle Scholar
  9. 9.
    Stergiou GS, Parati G, Vlachopoulos C, Achimastos A, Andreadis E, Asmar R, Avolio A, Benetos A, Bilo G, Boubouchairopoulou N, Boutouyrie P, Castiglioni P, de la Sierra A, Dolan E, Head G, Imai Y, Kario K, Kollias A, Kotsis V, Manios E, McManus R, Mengden T, Mihailidou A, Myers M, Niiranen T, Ochoa JE, Ohkubo T, Omboni S, Padfield P, Palatini P, Papaioannou T, Protogerou A, Redon J, Verdecchia P, Wang J, Zanchetti A, Mancia G, O Brien E (2016) Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement. J Hypertens 34(9):1665–1677CrossRefGoogle Scholar
  10. 10.
    Feng Y, Li Z, Liu J, Sun F, Ma L, Shen Y, Zhou Y (2018) Association of short-term blood pressure variability with cardiovascular mortality among incident hemodialysis patients. Ren Fail 40(1):259–264CrossRefGoogle Scholar
  11. 11.
    Wang Y, Qin Y, Fan X, Cai J, Ye W, Xia J, Li M, Li X, Li X, Chen L (2018) Variability in predialysis systolic blood pressure and long-term outcomes in hemodialysis patients. Kidney Blood Press Res 43(1):115–124CrossRefGoogle Scholar
  12. 12.
    Liao R, Li J, Xiong Y, Lin L, Wang L, Sun S, Su B (2018) Association of peridialysis blood pressure and its variability with cardiovascular events in hemodialysis patients. Kidney Blood Press Res 43(4):1352–1362CrossRefGoogle Scholar
  13. 13.
    Hickson LJ, Negrotto SM, Onuigbo M, Scott CG, Rule AD, Norby SM, Albright RC, Casey ET, Dillon JJ, Pellikka PA, Pislaru SV, Best PJM, Villarraga HR, Lin G, Williams AW, Nkomo VT (2016) Echocardiography criteria for structural heart disease in patients with end-stage renal disease initiating hemodialysis. J Am Coll Cardiol 67(10):1173–1182CrossRefGoogle Scholar
  14. 14.
    Movilli E, Viola BF, Brunori G, Gaggia P, Camerini C, Zubani R, Berlinghieri N, Cancarini G (2010) Long-term effects of arteriovenous fistula closure on echocardiographic functional and structural findings in hemodialysis patients: a prospective study. Am J Kidney Dis 55(4):682–689CrossRefGoogle Scholar
  15. 15.
    Iwashima Y, Horio T, Takami Y, Inenaga T, Nishikimi T, Takishita S, Kawano Y (2002) Effects of the creation of arteriovenous fistula for hemodialysis on cardiac function and natriuretic peptide levels in CRF. Am J Kidney Dis 40(5):974–982CrossRefGoogle Scholar
  16. 16.
    Ye WL, Fang LG, Ma J, Li XM (2013) Long-term effects of arteriovenous fistula on cardiac structure and function in non-diabetic hemodialysis patients. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 35(1):95–101Google Scholar
  17. 17.
    Reddy YNV, Obokata M, Dean PG, Melenovsky V, Nath KA, Borlaug BA (2017) Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease. Eur Heart J 38(24):1913–1923CrossRefGoogle Scholar
  18. 18.
    Shafi T, Sozio SM, Bandeen-Roche KJ, Ephraim PL, Luly JR, St PW, McDermott A, Scialla JJ, Crews DC, Tangri N, Miskulin DC, Michels WM, Jaar BG, Herzog CA, Zager PG, Meyer KB, Wu AW, Boulware LE (2014) Predialysis systolic BP variability and outcomes in hemodialysis patients. J Am Soc Nephrol 25(4):799–809CrossRefGoogle Scholar
  19. 19.
    Dinesh K, Kunaparaju S, Cape K, Flythe JE, Feldman HI, Brunelli SM (2011) a model of systolic blood pressure during the course of dialysis and clinical factors associated with various blood pressure behaviors. Am J Kidney Dis 58:794–803CrossRefGoogle Scholar
  20. 20.
    Chawla LS, Herzog CA, Costanzo MR, Tumlin J, Kellum JA, McCullough PA, Ronco C (2014) Proposal for a functional classification system of heart failure in patients with end-stage renal disease. J Am Coll Cardiol 63(13):1246–1252CrossRefGoogle Scholar
  21. 21.
    Sumida K, Molnar MZ, Potukuchi PK, Thomas F, Lu JL, Yamagata K, Kalantar-Zadeh K, Kovesdy CP (2017) Pre-end-stage renal disease visit-to-visit systolic blood pressure variability and post-end-stage renal disease mortality in incident dialysis patients. J Hypertens 35(9):1816–1824CrossRefGoogle Scholar
  22. 22.
    Flythe JE, Kunaparaju S, Dinesh K, Cape K, Feldman HI, Brunelli SM (2012) Factors Associated With intradialytic systolic blood pressure variability. Am J Kidney Dis 59(3):409–418CrossRefGoogle Scholar
  23. 23.
    Malik J (2018) Heart disease in chronic kidney disease—review of the mechanisms and the role of dialysis access. J Vasc Access 19(1):3–11CrossRefGoogle Scholar
  24. 24.
    Zamboli P, Lucà S, Borrelli S, Garofalo C, Liberti ME, Pacilio M, Lucà S, Palladino G, Punzi M (2018) High-flow arteriovenous fistula and heart failure: could the indexation of blood flow rate and echocardiography have a role in the identification of patients at higher risk? J Nephrol 31(6):975–983CrossRefGoogle Scholar
  25. 25.
    Alencar De Pinho N, Coscas R, Metzger M, Labeeuw M, Ayav C, Jacquelinet C, Massy ZA, Stengel B (2017) Vascular access conversion and patient outcome after hemodialysis initiation with a nonfunctional arteriovenous access: a prospective registry-based study. BMC Nephrol 18(1)Google Scholar
  26. 26.
    Kim HY, Bae EH, Ma SK, Kim SW (2017) Association between initial vascular access and survival in hemodialysis according to age. The Korean Journal of Internal MedicineGoogle Scholar
  27. 27.
    Raimann JG, Barth C, Usvyat LA, Preciado P, Canaud B, Etter M, Xu X, Guinsburg A, Marelli C, Duncan N, Power A, van der Sande FM, Kooman JP, Thijssen S, Wang Y, Kotanko P (2017) Dialysis access as an area of improvement in elderly incident hemodialysis patients: results from a cohort study from the international monitoring dialysis outcomes initiative. Am J Nephrol 45(6):486–496CrossRefGoogle Scholar
  28. 28.
    Brown RS, Patibandla BK, Goldfarb-Rumyantzev AS (2017) The survival benefit of “Fistula First, Catheter Last” in hemodialysis is primarily due to patient factors. J Am Soc Nephrol 28(2):645–652CrossRefGoogle Scholar
  29. 29.
    (2000) Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis 35 (6 Suppl 2):S1–S140Google Scholar
  30. 30.
    Rippe B, Oberg CM (2016) Albumin turnover in peritoneal and hemodialysis. Semin Dial 29(6):458–462CrossRefGoogle Scholar
  31. 31.
    Banerjee T, Kim SJ, Astor B, Shafi T, Coresh J, Powe NR (2014) Vascular access type, inflammatory markers, and mortality in incident hemodialysis patients: the choices for healthy outcomes in caring for end-stage renal disease (CHOICE) study. Am J Kidney Dis 64(6):954–961CrossRefGoogle Scholar

Copyright information

© Italian Society of Nephrology 2019

Authors and Affiliations

  1. 1.Department of Nephrology, West China HospitalSichuan UniversityChengduChina

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