P40 Arteriovenous Fistula, Blood Pressure and Arterial Reservoir-wave Analysis: Lessons From End-stage Renal Disease

DOI

10.2991/artres.k.191224.071How to use a DOI?

Abstract

Purpose/Background/Objectives: According to reservoir-wave theory, excess pressure (XSP) is analogous to flow and related to excess cardiac workload. In end-stage renal disease (ESRD) patients, we have shown that XSPI is associated with increased mortality and is higher in patients with arteriovenous fistula (AVF). Recently AVF has been proposed treatment for treatment of resistant hypertension. However, this benefit may be mitigated through an increase in cardiac output. Therefore, we examine whether XSPI increases after creation of an AVF in ESRD patients.

Methods: Hemodynamic assessments were performed within 1 month before and 6 months after creation of AVF in ESRD patients. Carotid pressure waves were recorded using arterial tonometry, calibrated using brachial diastolic and mean arterial pressure. Using pressure only approach, reservoir-wave analysis was used to derive reservoir pressure (RP), XSP and their integrals (RPI, XSPI).

Results: 38 patients (63% male, mean age 59 ± 15 years) were assessed 3.9 ± 1.2 months Post-AVF. Carotid RP decreased slightly (115 ± 18 vs 109 ± 24, p = 0.060), due to the reduction of diastolic BP (79 ± 10 vs 73 ± 12 mm Hg, p = 0.003). While, carotid systolic BP (123 ± 20 vs 119 ± 27 mm Hg, p = 0.380) remained unchanged, XSP and XSPI increased (XSP: 14 [12–19] to 17 [12–22] mmHg, p = 0.031; XSPI: 275 [212–335] to 334 [241–349] kPa.s, p = 0.015).

Conclusion: While AVF creation reduced diastolic BP, it resulted in higher XSPI, which has been associated with increased mortality. Therefore, the long-term efficacy of AVF in reducing clinical outcomes should be specifically addressed.

Copyright

© 2019 Association for Research into Arterial Structure and Physiology. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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TY  - JOUR
AU  - Mathilde Paré
AU  - Rémi Goupil
AU  - Catherine Fortier
AU  - Fabrice Mac-Way
AU  - Karine Marquis
AU  - Bernhard Hametner
AU  - Siegfried Wassertheurer
AU  - Martin Schultz
AU  - James E. Sharman
AU  - Mohsen Agharazii
PY  - 2020
DA  - 2020/02/15
TI  - P40 Arteriovenous Fistula, Blood Pressure and Arterial Reservoir-wave Analysis: Lessons From End-stage Renal Disease
JO  - Artery Research
SP  - S80
EP  - S80
VL  - 25
IS  - Supplement 1
SN  - 1876-4401
UR  - https://doi.org/10.2991/artres.k.191224.071
DO  - 10.2991/artres.k.191224.071
ID  - Paré2020
ER  -