Increased Excess Pressure After Creation of an Arteriovenous Fistula in End-Stage Renal Disease.
blood pressure
cardiovascular disease
hemodynamics
hypertension
nephrology and kidney
Journal
American journal of hypertension
ISSN: 1941-7225
Titre abrégé: Am J Hypertens
Pays: United States
ID NLM: 8803676
Informations de publication
Date de publication:
01 02 2022
01 02 2022
Historique:
received:
12
04
2021
revised:
12
09
2021
accepted:
14
10
2021
pubmed:
17
10
2021
medline:
21
4
2022
entrez:
16
10
2021
Statut:
ppublish
Résumé
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. 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). In 38 patients (63% male, age 59 ± 15 years), after AVF creation, brachial diastolic BP decreased (79 ± 10 vs. 72 ± 12 mm Hg, P = 0.002), but the reduction in systolic BP, was not statistically significant (133 ± 20 vs. 127 ± 26 mm Hg, P = 0.137). However, carotid XSP (14 [12-19] to 17 [12-22] mm Hg, 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). 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.
Sections du résumé
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).
RESURLTS
In 38 patients (63% male, age 59 ± 15 years), after AVF creation, brachial diastolic BP decreased (79 ± 10 vs. 72 ± 12 mm Hg, P = 0.002), but the reduction in systolic BP, was not statistically significant (133 ± 20 vs. 127 ± 26 mm Hg, P = 0.137). However, carotid XSP (14 [12-19] to 17 [12-22] mm Hg, 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).
CONCLUSIONS
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.
Identifiants
pubmed: 34655294
pii: 6398596
doi: 10.1093/ajh/hpab161
pmc: PMC8807157
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
149-155Subventions
Organisme : CIHR
ID : NET-54008
Pays : Canada
Informations de copyright
© American Journal of Hypertension, Ltd 2021. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Références
Hypertension. 2015 Mar;65(3):629-35
pubmed: 25534707
Hypertension. 2014 May;63(5):1050-5
pubmed: 24516104
Nephrol Dial Transplant. 2009 Nov;24(11):3441-6
pubmed: 19509025
J Am Soc Nephrol. 2013 Feb;24(3):465-73
pubmed: 23431075
Med Biol Eng Comput. 2012 Apr;50(4):419-24
pubmed: 22367750
J Am Heart Assoc. 2019 Feb 19;8(4):e011183
pubmed: 30764686
Circulation. 1997 Apr 1;95(7):1827-36
pubmed: 9107170
Artery Res. 2017 Jun;18:75-80
pubmed: 28626494
J Vasc Surg. 2018 Dec;68(6):1848-1857.e2
pubmed: 29779960
Am J Transplant. 2004 Dec;4(12):2038-44
pubmed: 15575907
Hypertension. 2009 Nov;54(5):1099-105
pubmed: 19720955
Intern Med. 2017;56(5):481-485
pubmed: 28250291
Nephrol Dial Transplant. 2014 Apr;29(4):892-8
pubmed: 24235075
Hypertension. 2015 Jul;66(1):93-8
pubmed: 26015448
Int J Cardiovasc Imaging. 2019 Mar;35(3):469-479
pubmed: 30328027
Am J Kidney Dis. 2004 May;43(5):e17-22
pubmed: 15112194
Am J Hypertens. 2017 Mar 1;30(3):271-278
pubmed: 27838626
Physiol Meas. 2018 Jun 28;39(6):064006
pubmed: 29870401
Comput Methods Programs Biomed. 2013 Mar;109(3):250-9
pubmed: 23107159
PLoS One. 2017 Jun 19;12(6):e0179938
pubmed: 28628659
J Am Soc Nephrol. 2004 Feb;15(2):477-86
pubmed: 14747396
J Am Heart Assoc. 2017 Nov 29;6(12):
pubmed: 29187389
Arterioscler Thromb Vasc Biol. 2014 Jul;34(7):1597-603
pubmed: 24812322
Kidney Int. 1999 May;55(5):2049-53
pubmed: 10231470
Int J Cardiol. 2014 Oct 20;176(3):1009-12
pubmed: 25109888
Hypertension. 2014 Jul;64(1):60-8
pubmed: 24821941
Lancet. 2015 Apr 25;385(9978):1634-41
pubmed: 25620016
Hypertension. 2013 Jul;62(1):154-60
pubmed: 23648699
Proc Inst Mech Eng H. 2020 Nov;234(11):1288-1299
pubmed: 32367773
J Am Heart Assoc. 2019 Jul 2;8(13):e012314
pubmed: 31220992
Am J Physiol Heart Circ Physiol. 2015 Oct;309(7):H1225-33
pubmed: 26276816
Am J Hypertens. 2020 Feb 22;33(2):137-145
pubmed: 31419806
Am J Physiol. 1958 Apr;193(1):147-50
pubmed: 13521000
Int J Cardiol. 2016 Jul 15;215:388-95
pubmed: 27128568
Circulation. 2019 Jun 18;139(25):2809-2818
pubmed: 31045455
Int J Cardiol. 2014 Mar 15;172(2):299-306
pubmed: 24485224
ASAIO J. 2009 Sep-Oct;55(5):484-93
pubmed: 19672193