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      About Blood Purification: 3.0 Impact Factor I 5.6 CiteScore I 0.83 Scimago Journal & Country Rank (SJR)

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      Arteriovenous Fistula Toxicity

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          Abstract

          The arteriovenous fistula (AVF) has been a mainstay of hemodialysis treatments and the preferred access route since its inception in the 1960s, due to its longevity and resistance to infection. However, the AVF is not benign. There is significant primary failure, as well as cardiac, vascular, and other, less well recognized, complications. Together, they represent toxicity, to which considerable morbidity and mortality can be attached. Official policy, based on guidelines where AVF toxicity is given short shrift, drives an increase in use of these devices, and may have undesired consequences.

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          Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula.

          James Cimino, B Hurwich, Frank J Brescia … (1966)
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            Pulmonary hypertension in patients with end-stage renal disease.

            Mordechai Yigla, Farid Nakhoul, Anat Sabag … (2003)
            The aims of this study were to evaluate the incidence of unexplained pulmonary hypertension (PH) among patients with end-stage renal disease (ESRD) and to suggest possible etiologic factors. The incidence of PH was prospectively estimated by Doppler echocardiography in 58 patients with ESRD receiving long-term hemodialysis via arteriovenous access, and in control groups of 5 patients receiving peritoneal dialysis (PD) and 12 predialysis patients without a known other cause to suggest the presence of PH. Clinical variables were compared between patients with and without PH receiving hemodialysis. Changes in pulmonary artery pressure (PAP) values before and after onset of hemodialysis via arteriovenous access, arteriovenous access compression, and successful kidney transplantation were recorded. PH > 35 mm Hg was found in 39.7% of patients receiving hemodialysis (mean +/- SD, 44 +/- 7 mm Hg; range, 37 to 65 mm Hg), in none of the patients receiving PD, and in 1 of 12 predialysis patients. Patients with PH receiving hemodialysis had a significantly higher cardiac output (6.9 L/min vs 5.5 L/min, p = 0.017). PH developed in four of six patients with normal PAP after onset of hemodialysis therapy via arteriovenous access. One-minute arteriovenous access compression in four patients decreased the mean systolic PAP from 52 +/- 7 to 41 +/- 4 mm Hg (p = 0.024). PH normalized in four of five patients receiving hemodialysis following kidney transplantation. Kaplan-Meier survival analysis according to PAP values revealed significant survival differences (p < 0.024). This study demonstrates a surprisingly high incidence of PH among patients with ESRD receiving long-term hemodialysis with surgical arteriovenous access. Both ESRD and long-term hemodialysis via arteriovenous access may be involved in the pathogenesis of PH by affecting pulmonary vascular resistance and cardiac output.
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              Arteriovenous fistula-associated high-output cardiac failure: a review of mechanisms.

              S. Pandeya, Timothy Lindsay, Jennifer M MacRae … (2004)
              High-output cardiac failure can be a rare complication of high-output arteriovenous fistula. The authors present a case in which a hemodialysis patient with a high-flow arteriovenous fistula has cardiac failure that improves with fistula closure. The hemodynamic effects of a fistula are reviewed, and the hemodialysis literature regarding high-output cardiac failure is summarized. To gain insight into the problem of high-output cardiac failure, research efforts should focus on the prospective monitoring of high-access flows.
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                Author and article information

                Journal
                Journal ID (publisher-id): BPU
                Journal ID (nlm-ta): Blood Purif
                Journal ID (doi): 10.1159/issn.0253-5068
                Title: Blood Purification
                Publisher: S. Karger AG
                ISSN (Print): 0253-5068
                ISSN (Electronic): 1421-9735
                Publication date Subscription-year: 2011
                Publication date (Print): January 2011
                Publication date (Electronic): 10 January 2011
                Volume: 31
                Issue: 1-3
                Pages: 113-120
                Affiliations
                aDepartment of Internal Medicine – Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany; bDivision of Nephrology and Transplantation, Hospital St. Bortolo, Vicenza, Italy; cDepartment of Nephrology, Free University of Berlin, Berlin, Germany; dDivision of Nephrology and Hypertension, Beth Israel Medical Center, New York, N.Y., USA
                Author notes
                *Richard Amerling, MD, Division of Nephrology and Hypertension, Beth Israel Medical Center, 350 East 17th Street, New York, NY 10003 (USA), E-Mail ramerlin@chpnet.org
                Article
                Publisher ID: 322695 Other ID: Blood Purif 2011;31:113–120
                DOI: 10.1159/000322695
                PubMed ID: 21228578
                SO-VID: 52734433-073b-4bfd-b900-43b981df214c
                Copyright © © 2011 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Figures: 9, Tables: 3, Pages: 8
                Categories
                Subject: 13th International Conference on Dialysis: Advances in Chronic Kidney Disease 2011

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Vascular access,Cardiovascular mortality,Arteriovenous fistula,Hemodialysis
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Vascular access, Cardiovascular mortality, Arteriovenous fistula, Hemodialysis

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