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Increased excess pressure after creation of an arteriovenous fistula in end stage renal disease


Pare, M and Goupil, R and Fortier, C and Mac-Way, F and Madore, F and Hametner, B and Wassertheurer, S and Schultz, MG and Sharman, JE and Agharazii, M, Increased excess pressure after creation of an arteriovenous fistula in end stage renal disease, American Journal of Hypertension ISSN 0895-7061 (2021) [Refereed Article]

DOI: doi:10.1093/ajh/hpab161


Background: Reservoir-wave analysis (RWA) separates the arterial waveform into reservoir and excess pressure (XSP) components, where XSP is analogous to flow and related to left ventricular workload. RWA provides more detailed information about the arterial tree than traditional blood pressure (BP) parameters. In end-stage renal disease (ESRD), we have previously shown that XSP is associated with increased mortality and is higher in patients with arteriovenous fistula (AVF). In this study, we examined whether XSP increases after creation of an AVF in ESRD.

Methods: Before and after a mean of 3.9 1.2 months following creation of AVF, carotid pressure waves were recorded using arterial tonometry. XSP and its integral (XSPI) were derived using RWA through pressure wave analysis alone. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (CF-PWV).

Results: In thirty-eight patients (63% male, age 59 15 years), after AVF creation, brachial diastolic BP decreased (79 10 vs 72 12 mmHg, P=0.002), but the reduction in systolic BP, was not statistically significant (133 20 vs 127 26 mmHg, P=0.137). However, carotid XSP (14 [12 - 19] to 17 [12 - 22] mmHg, P=0.031) and XSPI increased significantly (275 [212 - 335] to 334 [241 - 439] kPa∙s, P=0.015), despite a reduction in CF-PWV (13 3.6 vs 12 3.5 m/s, P=0.025).

Conclusion: Creation of an AVF resulted in increased XSP in this population, despite improvement in diastolic BP and aortic stiffness. These findings underline the complex hemodynamic impact of AVF on the cardiovascular system.

Item Details

Item Type:Refereed Article
Keywords:blood pressure, hypertension, nephrology, kidney disease, hemodynamics
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Schultz, MG (Dr Martin Schultz)
UTAS Author:Sharman, JE (Professor James Sharman)
ID Code:147137
Year Published:2021
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2021-10-14
Last Modified:2021-11-24

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