Are high flow arteriovenous accesses associated with worse haemodialysis?

Ivo Laranjinha, Patrícia Matias, Ana Azevedo, David Navarro, Carina Ferreira, Tiago Amaral, Marco Mendes, Inês Aires, Cristina Jorge, Célia Gil, Anibal Ferreira

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: An arteriovenous (AV) access flow (Qa) of 400 mL/min is usually sufficient for an effective hemodialysis (HD), but some accesses continue developing and become high flow accesses (HFA). Some authors postulated that an HFA might shift a significant portion of dialyzed blood from the cardiac output, which could decrease HD efficiency and lead to volume overload.

OBJECTIVE: The aim of our study was to evaluate if HFA is associated with reduced HD efficiency and/or volume overload in prevalent HD patients.

METHODS: We performed a 1-year retrospective study and assessed HD efficiency by the percentage of sessions in which the Kt/V > 1.4 and volume overload by bioimpedance spectroscopy.

RESULTS: The study included 304 prevalent HD patients with a mean age of 67.5 years; 62.5% were males, 36.2% were diabetics, with a median HD vintage of 48 months. Sixteen percent of the patients had a HFA (defined as Qa > 2 L/min). In multivariate analysis, patients with HFA presented higher risk of volume overload (OR = 2.67, 95%CI = 1.06-6.71) and severe volume overload (OR = 4.06, 95%CI = 1.01-16.39) and attained dry weight less frequently (OR = 0.37, 95%CI = 0.14-0.94). However, HFA was not associated with lower Kt/V.

CONCLUSION: Our results suggest that patients with HFA have higher risk of volume overload. However, contrarily to what has been postulated, HFA was not associated with less efficient dialysis, measured by Kt/V. Randomized controlled trials are needed to clarify these questions.

Original languageEnglish
Pages (from-to)136-142
JournalJornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Volume40
Issue number2
DOIs
Publication statusPublished - 1 Apr 2018

Keywords

  • aged
  • arteriovenous shunt
  • coronary artery blood flow
  • female
  • hemodialysis
  • human
  • lung circulation
  • male
  • middle aged
  • procedures
  • retrospective study
  • treatment outcome

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