Arteriovenous fistula, pulmonary hypertension and tricuspid dysfunction in renal transplant recipients. A possible solution
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Abstract
Introduction: Cardiovascular dysfunction is the first cause of death in patients with chronic kidney disease.
Methods: Observational, longitudinal and prospective study, which included 58 patients with functioning renal transplant who were studied different echocardiographic variables, before and six months after the closure of the arteriovenous fistula.
Results: The average age was 46.62 years and the most frequent was male 30 (51.72%). The flow of angioaccesses at the wrist level was demonstrated in 28 patients (45.9%) with evidence of regression of mean pulmonary artery pressure from 25.56 to 19.58 mmHg (p=0.002), more connoted for those of intermediate flow; 14. Also, the area of tricuspid insufficiency was greater for that group; from 3.15 to 1.96 cm2 (p=0.001). The pattern of mild dysfunction was observed in 38 patients (62.3%) prior to closure. Subsequent to this 27; (51.9%), exhibited minimal valvular insufficiency and 9 individuals (14.9%) did not show any degree of valvular dysfunction.
Conclusions: Closure of the arteriovenous fistula in patients with functioning renal transplantation contributed to decrease the risk of pulmonary hypertension and progression of tricuspid valve dysfunction.
References
Airy M, Lenihan CR, Ding VY, Montez-Rath ME, Cheng J, Navaneethan SD, et al. Association between type of vascular access used in hemodialysis patients and subsequent kidney transplant outcomes. Kidney Med [Internet]. 2019 Nov-Dec [citado 15/08/2022];1(6):383-90 https://doi.org/10.1016/j.xkme.2019.08.005
Birdwell K, Park M. Post - transplant cardiovascular disease. Clin J Am Soc Nephrol [Internet]. 2021 Sept [citado 21/07/2022];16:1878-89 https://doi.org/10.2215/CJN.00520121
Caughey MC, Detwiler RK, Sivak JA, Rose Jones LJ, Kshirsagar AV, Hinderliter AL. Five year outcomes of pulmonary hypertension with and without elevated left atrial pressure in patients evaluated for kidney transplantation. Transplantation [Internet]. 2020 Oct [citado 5/09/2021];104(10):2113-9. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316610/.
Celtik A, Alpay N, Celik A, Sezer TO, Turkmen A, Camsari T, Toz H, Sever MS, Hoscoskun C; Turkish Society of Nephrology Kidney Transplantation Working Group. Kidney transplant recipients with functioning grafts for more than 15 years. Transplant Proc [Internet]. 2013 Apr [citado 5/07/2022];45(3):904-7 https://doi.org/10.1016/j.transproceed.2013.02.051
Cruz RE, Ramírez JI, González Y, Hernández ME, Hernández OA, Batista R. Repercusión hemodinámica del cierre de la fístula arteriovenosa sobre el corazón derecho en trasplantados renales. Revista Cubana de Medicina [Internet]. 2020 Jul-Sep [citado 21/07/2022];59(3):e1371. Disponible en: https://www.revmedicina.sld.cu/index.php/med/article/view/1371/1318
Dundon BK, Torpey K, Nelson AJ, Wong DTL, Duncan RF, Meredith IT, et al. The deleterious effects of arteriovenous fistula - creation on the cardiovascular system: a longitudinal magnetic resonance imaging study. International Journal of Nephrology and Renovascular Disease [Internet]. 2014 Sept [citado 29/09/2022];7:337-45 https://doi.org/10.2147/IJNRD.S66390
Jeong JC, Ro H, Hwang YH, Lee HK, Ha J, Ahn C, et al. Cardiovascular diseases after kidney transplantation in Korea. J Korean Med Sci [Internet]. 2010 May [citado 5/09/2022];25(11):1589-94 https://doi.org/10.3346/jkms.2010.25.11.1589
Jeong S, Kwon H, Kim JY, Kim YH, Kwon T-W, Lee JB et al. Effect of arteriovenous access closure and timing on kidney transplant recipients. PLoS ONE [Internet]. 2019 Dec [citado 17/08/2022];14(12):e0226309 https//:doi.org/10.1371/journal.pone.0226309
Kaballo MA, Canney M, O’Kelly P, Williams Y, O’Seaghdha CM, Conlon PJ. A comparative analysis of survival of patients on dialysis and after kidney transplantation. Clin Kidney J [Internet]. 2018 Jun [citado 5/07/2022];11(3):389-93 https://dx.doi.org/10.1093/ckj/sfx117
Letachowicz K, Bardowska K, Królicki T, Kamińska D, Banasik M, Zajdel K, et al. The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients. Ren Fail [Internet]. 2021 Dec [citado 29/09/2022];43(1):113-22 https://dx.doi.org/10.1080/0886022X.2020.1865171
Martínez R, Ferreira F, García G, Cerezo I, Hernández R, Caravaca F. Insuficiencia cardiaca en la enfermedad renal crónica avanzada. Relación con el acceso vascular. Nefrología [Internet]. 2012 Dec [citado 5/09/2022];32(2):206-12 https://doi.org/10.3265/Nefrologia.pre2011.Dec.11223
Marwick TH, Amann K, Bangalore S, Cavalcante JL, Charytan DM, Craig JC, et al. Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney International [Internet]. 2019 Jun [citado 5/09/2022];96:836-49 https://doi.org/10.1016/j.kint.2019.06.025
Rabih F, Holden RL, Vasanth P, Pastan SO, Fisher MR, Trammell AW. Effect of pulmonary hypertension on 5 - year outcome of kidney transplantation. Pulmonary Circulation [Internet]. 2022 Jan [citado 5/09/2022];12(1):1-10 https://doi.org/10.1002/pul2.12010
Rao NN, Stokes MB, Rajwani A, Ullah S, Williams K, King D, et al. Effects of arteriovenous fistula ligation on cardiac structure and function in kidney transplant recipients. Circulation [Internet]. 2019 Jun [citado 17/08/2022];139(25):2809-18 https://doi.org/10.1161/CIRCULATIONAHA.118.038505
Soliman AR, Fathy A, Elkhatib M, Soliman MA, Shaheen N. Distance from treatment facility and risk of death from cardiovascular and infectious causes in renal transplant patients. Indian J Nephrol [Internet]. 2013 Oct [citado 5/07/2022];23(2):98-102. Disponible en: https://doi.org/10.4103/0971-4065.109406
Stoumpos S, Mark PB. Should we ligate arteriovenous fistulas in asymptomatic patients after kidney transplantation? Circulation [Internet]. 2019 Jun [citado 5/09/2022];139(25):2819-21. Disponible en: https://www.ahajournals.org/.
Tudoran M, Ciocarlie T, Mates A, Pescariu SA, AbuAwwad A, Tudoran C. Pulmonary hypertension in patients with end stage renal disease undergoing hemodialysis. Niger J Clin Pract [Internet]. 2020 Feb [citado 5/09/2022];23(2):198-204. https://doi.org/10.4103/njcp.njcp_278_19
Unal A, Duran M, Tasdemir K, Oymak S, Sipahioglu MH, Tokgoz B, et al. Does arterio - venous fistula creation affects development of pulmonary hypertension in hemodialysis patients? Ren Fail [Internet]. 2013 Jan [citado 5/09/2022];35(3):344-51 https://doi.org/10.3109/0886022x.2012.760407
Zheng H, Bu S, Song Y, Wang M, Wu J, Chen J. To ligate or not to ligate: A metaanalysis of cardiac effects and allograft function following arteriovenous fistula closure in renal transplant recipients. Ann Vasc Surg [Internet]. 2020 Feb [citado 17/08/2022];63:287-92 https://doi.org/10.1016/j.avsg.2019.06.040