Abstract: SA-PO973
Echocardiographic Measurements Before Different AVF Types Created Before and After Hemodialysis Initiation and the Contribution to Pulmonary Hypertension
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Duque Ballesteros, Juan Camilo, University of Miami, Miami, Florida, United States
- Martinez, Laisel, University of Miami, Miami, Florida, United States
- Vazquez-Padron, Roberto I., University of Miami, Miami, Florida, United States
- Labove, Hannah, University of Miami/Jackson Memorial Hospital, Miami, Florida, United States
- Escobar, Luis A., University of Miami, Miami, Florida, United States
- Tabbara, Marwan, University of Miami, Miller School of Medicine, Miami, Florida, United States
Background
Pulmonary hypertension (PH; PAP of 25 mmHg at rest or higher than 30 mmHg with exercise) is common in end-stage renal disease patients, which has been associated with uremic toxins, volume status, and hemodynamic changes that occur with vascular access creation. Little is known about the effects that different vascular access techniques, performed before or after initiation of dialysis, have on echocardiographic measurements.
Methods
A retrospective study was performed at the University of Miami Hospital/Jackson Memorial Health System from 2009 to 2014, evaluating patients who underwent an arteriovenous fistula (AVF) creation for hemodialysis. Patients who had a 2-D echocardiogram done before and after surgical AVF creation were analyzed. A total of 125 patients were included. From these, 22 patients had the AVF created before the need for dialysis, while 103 patients had already initiated hemodialysis (HD) using a dialysis catheter. The 2-D echo measurements analyzed were ejection fraction EF (%), right ventricular systolic pressure (RVSP; mmHg), and right ventricular end diastole (RVDd; cm).
Results
The mean age at the time of AVF creation was 50 ± 12 years in patients with AVFs created before HD initiation, and 51 ± 13 in the after HD subgroup. 55 and 62% of patients were men, and essential hypertension was present in 100% of participants in both cohorts. The prevalence of diabetes mellitus was 68% and 59% in patients with AVF created before and after HD initiation, respectively. The AVF inflow was brachial-based in 50% and radial-based in 50% of the accesses in the pre-dialysis group, compared to 58% brachial vs. 42% radial in AVFs created after HD initiation.
No statistical differences were found in RVSP or RVDd comparing brachial-based vs. radial-based inflow AVFs in patients with access created before or after HD initiation. However, EF (%) was higher in patients with radial-based vs. brachial-based AVFs when the access was created after HD initiation (53.8 ± 11 vs. 57.8 ± 6, p=0.04).
Conclusion
With these results, we can conclude that timing of AVF creation or type of arterial inflow has no correlation with PH in end-stage renal disease patients. The differences in EF in the after HD subgroup need to be further investigated.