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Abstract: SA-PO403

Blood Pressure Changes After Arteriovenous Fistula Creation in Hemodialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Duque, Juan Camilo, University of Miami School of Medicine, Miami, Florida, United States
  • Manzur-Pineda, Karen, University of Miami School of Medicine, Miami, Florida, United States
  • Martinez, Laisel, University of Miami School of Medicine, Miami, Florida, United States
  • Dejman, Adriana, University of Miami School of Medicine, Miami, Florida, United States
  • Tabbara, Marwan, University of Miami School of Medicine, Miami, Florida, United States
  • Vazquez-Padron, Roberto I., University of Miami School of Medicine, Miami, Florida, United States
Background

Hypertension (HTN) is highly prevalent in patients with end stage kidney disease (ESKD), reporting a rate of up to 86%. However, accepted definitions of HTN and blood pressure (BP) targets have not been established. Initiation of HD may impact the management of HTN. In addition, an arteriovenous fistula (AVF) creation poses significant hemodynamic changes. Studies have shown reduction in 24-hour ambulatory BP after a central AVF creation in patients with severe HTN and preserved renal function. We evaluate the effect of an AVF creation for dialysis on BP changes.

Methods

Retrospective study from 2019 to 2020 evaluated 159 patients who underwent a hemodialysis AVF creation. Vital signs were recorded by the same clinic staff and using the same equipment at five different time points: vein mapping, surgical creation, first post-surgical follow-up, second surgery (AVF transposition), and last follow-up before AVF is ready for cannulation. Demographic data, comorbidities, and pharmacological antihypertensive regimen were also collected.

Results

The mean age at AVF creation was 58 ± 13 years with a BMI average of 23.9 ± 5.3 kg/m2. A 56.7% of the cohort were Hispanic, 37.1% African American, and 6.2% Caucasian. HTN was present in (74.2%) and diabetes (40.2%). 96 patients were on HD using a dialysis catheter, and the rest were CKD stage 5 not on HD. A 52.7% were on CCB, Beta blockers in 50.2%, loop diuretics in 31.4%, hydralazine in 21.3%, ACEI/ARBs in 16.9%, clonidine in 10.6%, and isosorbide in 4.4%. Average BP during the vein mapping was 137.78/76.3± 25.9/12.5 mmHg with heart rate (HR) of 84.4±75; at the AVF creation 134.7/73.1±24/12.7 mmHg with HR of 73.2±11.8; at the first follow-up 135.4/71.6±23.1/11.7 mmHg with HR of 80.8±12; at the second surgical intervention 132.4/72.8±21.4/11.7 mmHg with HR of 74.3±11; and last follow-up 158.3/74±18/12.7 mmHg with HR of 81.8±13. No correlation was found between collected covariates and BP changes, and no improvement in BP was found.

Conclusion

Hypertension is highly prevalent in CKD 5 and ESKD patients requiring multipharmacological management. An AVF creation did not improve BP control in the short-term follow-up in our population. Moreover, we can conclude that other comorbid conditions do not correlate with hemodialysis AVF creation and BP control.

Funding

  • NIDDK Support