Document Detail

Haemodialysis arteriovenous access--a prospective haemodynamic evaluation.
MedLine Citation:
PMID:  8649659     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Factors affecting cardiac function in dialysis patients include arterial blood pressure, anaemia, intravascular volume, and the arteriovenous (a-v) access. Cardiac failure has been directly attributed to dialysis a-v access in several cases. The contribution of the a-v access to cardiac performance has been tested, in the past, by a short manual compression on the fistula, but this technique has obvious limitations. METHODS: The present study examined prospectively the effect of dialysis a-v access on both cardiac function and various hormonal responses. Ten patients (age, mean +/- SD, 59.6 +/- 12.3) with end-stage renal failure being prepared for chronic dialysis therapy were included. All patients underwent an echocardiographic study before and 2 weeks after the creation of the a-v access. Plasma atrial natriuretic peptide (ANP), plasma renin activity (PRA), and plasma aldosterone were measured at the same time periods. RESULTS: Following the creation of the a-v fistula or graft, shortening fraction increased by 15.8 +/- 6.3% (P < 0.01), stroke volume increased by 21.9 +/- 5.3% (P < 0.01), ejection fraction increased by 10.6 +/- 4.5% (P < 0.02), cardiac output increased by 19.0 +/- 6.9% (P < 0.02), and cardiac index increased by 18.3 +/- 7.1% (P = 0.05). Systemic vascular resistance decreased by 23.5 +/- 7.1% (P < 0.01). There was no change in blood pressure, heart rate, weight, haemoglobin or serum creatinine. ANP increased by 83.7 +/- 17.0% following the a-v access operation (P < 0.001), PRA decreased by 41.2 +/- 10.0% (P < 0.05), and plasma aldosterone did not change. None of the patients developed overt high-output cardiac failure. CONCLUSIONS: This study shows that at least in the short term following the creation of a dialysis a-v access, a mild state of volume overload develops, which is offset by the ?unloading' effect of the decreased peripheral vascular resistance; the latter is probably mediated by secretion of ANP in response to atrial stretching.
Y Ori; A Korzets; M Katz; Y Perek; I Zahavi; U Gafter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  11     ISSN:  0931-0509     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  1996 Jan 
Date Detail:
Created Date:  1996-07-23     Completed Date:  1996-07-23     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  94-7     Citation Subset:  IM    
Nephrology Department, Hasharon Hospital, Petah Tikva, Israel.
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MeSH Terms
Arteriovenous Fistula
Atrial Natriuretic Factor / blood
Catheters, Indwelling*
Creatinine / blood
Hemodynamics / physiology*
Hemoglobins / metabolism
Kidney Failure, Chronic / blood,  physiopathology,  therapy*
Middle Aged
Prospective Studies
Renal Dialysis / methods*
Renin / blood
Reg. No./Substance:
0/Hemoglobins; 60-27-5/Creatinine; 85637-73-6/Atrial Natriuretic Factor; EC

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