| The impact of arteriovenous fistulas on aortic stiffness in patients with chronic kidney disease. | |
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MedLine Citation:
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PMID: 19509025 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The creation of arteriovenous fistulas (AVF) in patients with advanced chronic kidney disease (CKD) has been shown to have adverse effects on their central pulse wave profile suggesting a likely increase in arterial stiffness. The aim of the present study was to directly evaluate the effect of AVF on arterial stiffness. Method. Thirty-one stage-5 CKD patients underwent haemodynamic assessment prior to and 3 months after creation of AVF. Haemodynamic assessment included measurement of blood pressure (BP), central and carotidal pulse wave profile analysis, and carotido-femoral and carotido-radial pulse wave velocities (PWV). Pre-AVF and post-AVF haemodynamic parameters were compared using the Wilcoxon signed-rank test or the paired Student t-test as appropriate. Pearson correlations, single and multiple linear regressions, were used to determine the association between variables. RESULTS: After creation of AVF, peripheral and central BPs decreased without significant change in heart rate (HR) or pulse pressure. Carotido-femoral PWV ((c-f)PWV) fell from 13.2 +/- 4.1 to 11.7 +/- 3.1 m/s (P < 0.001). There was an increase in the central augmentation index (20.8% +/- 11.5 versus 23.7% +/- 11.6, P = 0.07) of borderline significance, and a significant reduction in the subendocardial viability ratio (153% +/- 34 versus 143% +/- 32, P < 0.05), which was mainly the result of a decrease in the diastolic pressure time index (DPTI) without any significant change in the diastolic duration. The reduction of (c-f)PWV was explained by changes in mean BP and HR (R(2) = 0.29). The reduction in DPTI was related to changes in central diastolic BP and changes in end-systolic BP (adjusted R(2) = 0.87). The significant improvement in aortic stiffness was mostly the result of the relative reduction of (c-f)PWV in the subgroup of patients with baseline (c-f)PWV above the median value of 13 m/s. CONCLUSION: The creation of AVF is associated with a passive improvement of aortic stiffness especially in patients with stiffer arteries. This improvement in arterial stiffness could potentially be beneficial to the cardiovascular system despite an associated deterioration in the aortic pulse wave profile. |
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Authors:
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Mihai S Utescu; Am??lie LeBoeuf; Nadia Chbinou; Simon Desmeules; Marcel Lebel; Mohsen Agharazii |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2009-06-09 |
Journal Detail:
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Title: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Volume: 24 ISSN: 1460-2385 ISO Abbreviation: Nephrol. Dial. Transplant. Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2009-10-16 Completed Date: 2010-01-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8706402 Medline TA: Nephrol Dial Transplant Country: England |
Other Details:
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Languages: eng Pagination: 3441-6 Citation Subset: IM |
Affiliation:
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Division of Nephrology, Department of Medicine, CHUQ Research Centre, L'H??tel-Dieu de Qu??bec Hospital, Universit?? Laval, Qu??bec, QC, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aorta / physiopathology* Arteriovenous Shunt, Surgical* Blood Flow Velocity Blood Pressure Chronic Disease Female Heart Rate Humans Kidney Diseases / physiopathology* Male Middle Aged |
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