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Increased excess pressure after creation of an arteriovenous fistula in end stage renal disease

Pare, M, Goupil, R, Fortier, C, Mac-Way, F, Madore, F, Hametner, B, Wassertheurer, S, Schultz, MG ORCID: 0000-0003-3458-1811, Sharman, JE ORCID: 0000-0003-2792-0811 and Agharazii, M 2021 , 'Increased excess pressure after creation of an arteriovenous fistula in end stage renal disease' , American Journal of Hypertension , doi: 10.1093/ajh/hpab161.

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Background: Reservoir-wave analysis (RWA) separates the arterial waveform into reservoir and excess pressure (XSP) components, where XSP is analogous to flow and related to left ventricular workload. RWA provides more detailed information about the arterial tree than traditional blood pressure (BP) parameters. In end-stage renal disease (ESRD), we have previously shown that XSP is associated with increased mortality and is higher in patients with arteriovenous fistula (AVF). In this study, we examined whether XSP increases after creation of an AVF in ESRD.Methods: Before and after a mean of 3.9 ± 1.2 months following creation of AVF, carotid pressure waves were recorded using arterial tonometry. XSP and its integral (XSPI) were derived using RWA through pressure wave analysis alone. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (CF-PWV).Results: In thirty-eight patients (63% male, age 59 ± 15 years), after AVF creation, brachial diastolic BP decreased (79 ± 10 vs 72 ± 12 mmHg, P=0.002), but the reduction in systolic BP, was not statistically significant (133 ± 20 vs 127 ± 26 mmHg, P=0.137). However, carotid XSP (14 [12 - 19] to 17 [12 - 22] mmHg, P=0.031) and XSPI increased significantly (275 [212 - 335] to 334 [241 - 439] kPa∙s, P=0.015), despite a reduction in CF-PWV (13 ± 3.6 vs 12 ± 3.5 m/s, P=0.025).Conclusion: Creation of an AVF resulted in increased XSP in this population, despite improvement in diastolic BP and aortic stiffness. These findings underline the complex hemodynamic impact of AVF on the cardiovascular system.

Item Type: Article
Authors/Creators:Pare, M and Goupil, R and Fortier, C and Mac-Way, F and Madore, F and Hametner, B and Wassertheurer, S and Schultz, MG and Sharman, JE and Agharazii, M
Keywords: blood pressure, hypertension, nephrology, kidney disease, hemodynamics
Journal or Publication Title: American Journal of Hypertension
Publisher: Elsevier Science Inc
ISSN: 0895-7061
DOI / ID Number: 10.1093/ajh/hpab161
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