Angioaccess for hemodialysis in kidney transplantation Hemodynamic implications for the left heart

Angioaccess for hemodialysis in kidney transplantation
Hemodynamic implications for the left heart

Main Article Content

Rafael Enrique Cruz Abascal
José Ignacio Ramírez Gómez
Carlos Gutiérrez Gutiérrez
Raunel Batista Hernández
Milagro Estrella Hernández
Eligio Eduardo Barreto Fiu

Abstract

Cardiovascular complications represent the main cause of morbidity and mortality in patients with chronic renal disease, so the objective of this article is to demonstrate the influence of the patency of the arteriovenous fistula on echocardiographic variables measured in the left heart. For this, a multivariate study, longitudinal, prospective and controlled study of independent groups after an intervention that included 39 patients who had their angioaccess closed (study group) and 42 who were not exposed to surgery (control group). Both groups exhibited functional kidney transplantation. The main results emerge when comparing the prevalence between the study group and the control group, the average age; 45.6 and 44.1 years, the male sex, 24 (60%) and 23 (53.5%) and the white skin color; 33 (82.5%) and 32 (74.4%). The most frequent etiology of the original nephropathy was hypertensive vascular nephropathy; 12 (30%) vs 14 (32.6%). Among the clinical manifestations, remission of palpitations and dyspnea on exertion were evidenced in the study  group. With regard to blood pressure, for the systolic it ranged from 123 ±13.4 to 120.5 ±9.2 vs. 125.6 ±8.4 to 128 ±8.3 mmHg (p= 0.000), while the diastolic varied from; 76.8 ±7.5 to 76.3 ±6.2 vs. 78.6 ±4.9 to 82.4 ±3.9 mmHg (p= 0.000). The hematocrit had equivalent values; 0.43 ±0.06 and 0.45 ±0.06 vs 0.42 ±0.05 and 0.42 ±0.06 l/l (p= 0.035) and the serum creatinine showed decrease in the operated patients from; 106.8 ±26.2 to 99.8 ±23.9 μMol/l vs 114 ±27.8 to 120.3 ±31 μMol/l (p= 0.002). The echocardiographic variables measured comparatively according to the location of the angioaccesses at the left elbow level; diameter of the left ventricle: 3.12 ±4.08 vs 1.48 ±3.46 mms (p=0.001), ejection fraction of the left ventricle: 2.99 ±5.47 vs -1.98 ±6.23 % (p=0.018) and the telediasolic volume: -23 ±33.41 vs 10.86 ±36.87 ml (p=0.006). The contralateral elbow revealed; for the left ventricular ejection fraction: 3.32 ±3.42 vs -2.18 ±4.78 % (p=0.037) and for cardiac output: -1.29 ±0.88 vs -0.26 ±0.86 l/min (0.020). The conclusions show that the our study has shown that closing the angioaccess to patients with functioning renal transplants with respect to those not operated, contributes to the regression of morphological and hemodynamic alterations observed by transthoracic echocardiography in the left heart at the different locations of the vascular accesses.

References

Al-Jaishi AA, Liu AR, Lok CE, Zhang JC, Moist LM. (2016). Complications of the arteriovenous fistula: a systematic review. J Am Soc Nephrol.28(6):1839-50. doi: 10.1681/ASN.2016040412.

Ayora AS, Alonso A, Pérez D, Ramírez JI, Cruz RE. (2016) Manifestaciones cardiovasculares en pacientes tratados con hemodiálisis periódica por fístula arteriovenosa funcional. CorSalud. 8(2):102-10.

Bardowska K, Letachowicz K, Kamińska D, Kusztal M, Gołębiowski T, Tomasz Królicki T, et al. The attitude of kidney transplant recipients towards elective arteriovenous fistula ligation. PLoS ONE. 2020;15(7): e0234931. https://doi.org/10.1371/journal.pone.0234931

Basile C, Vernaglione L, Casucci F, Libutti P, Lisi P, Rossi L, et al. (2016). The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system. Clin Kidney J. 9(5):729-34. doi: 10.1093/ckj/sfw063

Brescia MJ, Cimino JE, Appel K, Hurwick BF. (1966). Chronic hemodialysis using venipuncture and a surgically created arteriovenous shunt. N Engl J Med. 275(20):1089-92.

Brosius FC, Hostetter TH, Kelepouris E, Mitsnefes MM, Moe SM, Moore MA, et al. (2006) Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease. A Science Advisory from the American Heart Association Kidney and Cardiovascular DiseaseCouncil; the Councils on High Blood Pressure Research, CardiovascularDisease in the Young, and Epidemiology and Prevention; and the Quality of Care and outcomes Research Interdisciplinary Working Group.Developed in Collaboration with the National Kidney Foundation. Circulation. 2006; 114:1083-7. doi: 10.1161/CIRCULATIONAHA.106.177321.

Celtik A, Alpay N, Celik A, Sezer TO, Turkmen A, Camsari T, Toz H, Sever MS, Hoscoskun C. (2013). Turkish Society of Nephrology Kidney Transplantation Working Group. Kidney transplant recipients with functioning grafts for more than 15 years. Transplant Proc.;45(3):904-7.

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. 2020;59(3): e1371. Consultado el 15 de diciembre de 2020 en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=56968

Dundon BK, Torpey K, Nelson AJ, Wong DTL, Duncan RF, Meredith IT, et al. (2014) The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study. International Journal of Nephrology and Renovascular Disease.7:337-45. Consultado el 15 de diciembre de 2020 en: https://research.monash.edu/en/publications/the-deleterious-effects-of-arteriovenous-fistula-creation-on-the-

Einollahi B, Ghahrodi MS. (2012). Hemodialysis arteriovenous fistula after transplant. To keep or not to keep? IJKD.6:159-65.

Glowinski J, Malyszko J, Glowinska I, Mysliwiec M. (2012) To close or not to close: fistula ligation and cardiac function in kidney allograft recipients. Pol Arch Med Wewn.122(7-8):348-52. doi: 10.20452/pamw.1349.

Gkotsis G, Jennings WC, Malik J, Mallios A, Taubman K.(2015) Treatment of high flow arteriovenous fistulas after successful renal transplant using a simple precision banding technique. Annals of Vascular Surgery. 31:85-90. DOI: 10.1016/j.avsg.2015.08.012

Gulmez O. (2017). Cardiovascular evaluation of renal transplant recipients. J Clin Exp Cardiolog;8(9):1-5.

Hetz P, Pirklbauer M, Müllerb S, Posch L, Gummerer M, Tiefenthaler M. (2020) Prophylactic ligature of AV fistula prevents high output heart failure after kidney transplantation. Am J Nephrol. 51:511-9. https://doi.org/10.1159/000508957

Hicks CW, Bae S, Pozo ME, Di Brito SR, Abularrage CJ, Segev DL, et al. (2019). Practice patterns in arteriovenousfistulaligation among kidney transplant recipients in the United States Renal Data Systems. J Vasc Surg.70(3):842-52. DOI: 10.1016/j.jvs.2018.11.048

Ikizler, TA.(2020). Arteriovenous fistulas in patients with kidney transplantation. Kidney International. 97:20-1. DOI: 10.1016/j.kint.2019.09.012

Jeong S, Kwon H, Kim JY, Kim YH, Kwon T-W, Lee JB et al. (2019) Effect of arteriovenous access closure and timing on kidney transplant recipients. PLoS ONE.14(12): e0226309. https://doi.org/10.1371/journal.pone.0226309

Laranjinha I, Matias P, Oliveira R, Casqueiro A, Bento MT, Carvalho AN, et al.(2019) The impact of functioning hemodialysis arteriovenous accesses on renal graft perfusion: Results of a pilot study. J Vasc Access. 20(5):482-7. https://doi.org/10.1177/1129729818817248

Martínez R, Ferreira F, García G, Cerezo I, Hernández R, Caravaca F. (2012) Insuficiencia cardiaca en la enfermedad renal crónica avanzada. Relación con el acceso vascular. Nefrología. 2012;32(2):206-12.

Papasotiriou M, Xanthopoulou I, Ntrinias T, Kalliakmani P, Koutsogiannis N, Davlouros P, et al. (2019) Impact of arteriovenous fistula on cardiac size and function in kidney transplant recipients: A retrospective evaluation of 5-year echocardiographic outcome. Exp Clin Transplant. 2019;17(5):619-26. DOI: 10.6002/ect.2018.0331

Rao NN, Stokes MB, Rajwani A, Ullah S, Williams K, King D, et al. (2019).Effects of arteriovenous fistula ligation on cardiac structure and function in kidney transplant recipients. Circulation.139(25):2809-18. https://doi.org/10.1161/CIRCULATIONAHA.118.038505

Rao NN, Dundon BK, Worthley MI, Faull RJ. (2016) The impact of arteriovenous fistulaefor hemodialysis on the cardiovascular system. Semin Dial. 29(3):214-21. DOI: 10.1111/sdi.12459

Raza F, Alkhouli M, Rogers F, Vaidya A, Forfia P. (2015). Case series of 5 patients with end-stage renal disease with reversible dyspnea, heart failure, and pulmonary hypertension related to arteriovenous dialysis access. Pulm Circ. 2015;5(2):398-406. doi: 10.1086/681266

Reddy YNV, Obokata M, Dean PG, Melenovski 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):1913-23.

Schier T, Göbel G, Bösmüller C, Gruber I, Tiefenthaler M. (2013). Incidence of arteriovenous fistula closure due to high-output cardiac failure in kidney-transplanted patients. Clin Transplant. 2013;27:858-65. DOI: 10.1111/ctr.12248

Soleimani MJ, Shahrokh H, Shadpour P, Shirani M, Arasteh S. (2012). Impact of dialysis access fistula on cardiac function after kidney transplantation. IJKD;6:198-202.

Unger P, Xhaët O, Wissing KM, Najem B, Dehon P, van de Borne P.(2008) Arteriovenous fistula closure after renal transplantation: A prospective study with 24-hour ambulatory blood pressure monitoring. Transplantation. 85(3):482-5. DOI: 10.1097/tp.0b013e318160f163

Vanderweckene P, Weekers L, Lancellotti P, Jouret F. (2018) Controversies in the management of the haemodialysis-related arteriovenous fistula following kidney transplantation. Clinical Kidney Journal. 11(3):406-12. doi: 10.1093/ckj/sfx113

Vajdič B, Arnol M, Ponikvar R, Kandus A, Buturović-Ponikvar J. (2010) Functional status of hemodialysis arteriovenous fistula in kidney transplant recipients as a predictor of allograft function and survival. Transplant Proc. 42(10):4006-9. DOI: 10.1016/j.transproceed.2010.09.057

Voorzaat BM, Janmaat CJ, Wilschut ED, Van Der Bogt KEA, Dekker FW, Rotmans JI.(2019). No consensus on physicians ̀ preferences on vascular access management after kidney transplantation: Results of a multi-nationalsurvey. The Journal of Vascular access. 2019;20(1):52-9. doi: 10.1177/1129729818776905

Voorzaat BM, van Schaik J, Siebelink HM, Tordoir JH, Rotmans J.I.(2016) The pros and cons of preserving a functioning arteriovenous fistula after kidney transplantation. J Vasc Access.17(Suppl 1): S16-22. https://doi.org/10.5301/jva.5000525

Wasse H, Singapuri MS.(2010). High-output heart failure: how to define it, when to tret it, and how to treat it. Semin Nephrol. 2010;32(6):551-7. DOI: 10.1016/j.semnephrol.2012.10.006

Weekers L, Vanderweckene P, Pottel H, Castanares-Zapatero D, Bonvoisin C, Hamoir E, et al. (2017).The closure of arteriovenous fistula in kidney transplant recipients is associated with an acceleration of kidney function decline. Nephrol Dial Transplant. 32:196-200. doi: 10.1093/ndt/gfw351.

Zheng H, Bu S, Song Y, Wang M, Wu J, Chen J. (2020)To ligate or not to ligate: A meta-analysis of cardiac effects and allograft function following arteriovenous fistula closure in renal transplant recipients. Ann Vasc Surg. 2020;63:287-92. . DOI: https://doi.org/10.1016/j.avsg.2019.06.040