Impact of vascular access intervention therapy on cardiac load in hemodialysis patients

Takayuki Adachi; Tsutomu Sakurada; Takanori Otowa; Keita Uehara; Shina Sueki; Shigeki Kojima; Nagayuki Kaneshiro; Katsuomi Matsui; Tadahisa Tomohiro; Yugo Shibagaki

doi:10.1111/hdi.12460

Impact of vascular access intervention therapy on cardiac load in hemodialysis patients

Hemodial Int. 2016 Oct:20 Suppl 1:S12-S16. doi: 10.1111/hdi.12460.

Authors

Affiliations

¹ Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan. takayukimail1207@yahoo.co.jp.
² Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.
³ Division of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, Kanagawa, Japan.
⁴ Division of Nephrology and Hypertension, Yokohama City Seibu Hospital, St. Marianna University School of Medicine, Kanagawa, Japan.
⁵ Noborito Clinic, Kanagawa, Japan.

PMID: 27669543
DOI: 10.1111/hdi.12460

Abstract

Vascular access intervention therapy (VAIVT) has been positioned as the first choice of treatment for stenosis lesions frequently observed in arteriovenous fistula (AVF) for hemodialysis patients in Japan. Furthermore, increased blood flow can provide a stable dialysis. In contrast, it has been reported that excess blood flow of AVF causes high-output heart failure. Although VAIVT is used to increase blood flow of AVF, the impact of VAIVT on cardiac load has been rarely reported. We examined the factors associated with cardiac load in hemodialysis patients undergoing VAIVT by measuring levels of α human atrial natriuretic polypeptide (hANP) and brain natriuretic peptide (BNP) before and after VAIVT. Data were extracted on hemodialysis patients who underwent measurements of αhANP and BNP in before and after VAIVT at our facility and related facilities between February 2014 and December 2014. Nineteeen patients (median age, 73.0 [66.5-80.5] years; male, 52.6%; 36.8% with diabetes; median duration of dialysis treatment, 50.0 [21-109] months) were enrolled in this study. Flow volume of AVF was higher after VAIVT than that before VAIVT (442.0 vs. 758.0 mL/minute, P < 0.001). Moreover, resistance index (RI) of AVF after VAIVT was lower than that before VAIVT (0.61 vs. 0.53, P < 0.01). Although αhANP did not change before and after VAIVT (55.6 vs. 54.9 pg/mL, P = 0.099), BNP after VAIVT was significantly higher than that before VAIVT (145.2 vs. 175.0 pg/mL, P < 0.05). Factors correlated with the increase in BNP were flow volume of AVF before VAIVT (r = -0.458, P = 0.049) and levels of BNP before VAIVT (r = 0.472, P = 0.041). There was no significant correlation between the increase in αhANP with flow volume of AVF before VAIVT, levels of αhANP before VAIVT. Patients with high levels of BNP and low flow volume of AVF before VAIVT were considered to have a high risk of developing heart failure after VAIVT.

Keywords: Vascular access intervention therapy; arteriovenous fistula; brain natriuretic peptide; cardiac load; hemodialysis.