The impact of functioning hemodialysis arteriovenous accesses on renal graft perfusion: Results of a pilot study

Ivo Laranjinha, Patricia Matias, Regina Oliveira, Ana Casqueiro, Maria Teresa Bento, Ana Paula Carvalho, Teresa Adragão, Cristina Jorge, Margarida Bruges, Rita Birne, Domingos Machado, André Weigert

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Abstract

INTRODUCTION:: After a kidney transplant, it is unknown whether the maintenance of a functioning hemodialysis arteriovenous access could have deleterious effects on renal grafts. We hypothesize that maintaining an arteriovenous access can deviate a significant proportion of the cardiac output from the renal graft. The aim of this study was to investigate whether a temporary closure of the arteriovenous access could lead to an increase in graft perfusion.

METHODS:: We conducted a study in 17 kidney-transplanted patients with a functioning arteriovenous access. We evaluated, at baseline and 30 s after compression of the arteriovenous access (access flow occlusion), the hemodynamic parameters and the renal resistive index of the graft by Doppler ultrasound.

RESULTS:: After arteriovenous access occlusion 82.4% (n = 14) of the patients had a decrease in resistive index. All patients had a decrease in heart rate (67 vs 58 bpm, p < 0.001) and 14 (82.4%) had an increase in mean blood pressure (98.3 vs 101.7 mm Hg, p = 0.044). There was a significant decrease in the resistive index (ΔRI) after the access occlusion (0.68 vs 0.64, p = 0.030). We found a negative correlation in Qa (r2 = -0.55, p = 0.022) with the ΔRI, and Qa was an independent predictor of ΔRI in a model adjusted to pre-occlusion resistive index.

CONCLUSION:: Our results showed that temporary occlusion of an arteriovenous access causes a significant decline in renal graft resistive index and this decline is higher with the occlusion of accesses with higher Qa. These results suggest that the maintenance of arteriovenous accesses, mainly those with higher Qa, can decrease renal graft perfusion.

Original languageEnglish
Pages (from-to)482.487
JournalJournal of Vascular Access
Volume20
Issue number5
Early online date6 Dec 2018
DOIs
Publication statusPublished - Sep 2019

Keywords

  • Arteriovenous accesses
  • graft perfusion
  • renal transplantation

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    Laranjinha, I., Matias, P., Oliveira, R., Casqueiro, A., Bento, M. T., Carvalho, A. P., Adragão, T., Jorge, C., Bruges, M., Birne, R., Machado, D., & Weigert, A. (2019). The impact of functioning hemodialysis arteriovenous accesses on renal graft perfusion: Results of a pilot study. Journal of Vascular Access, 20(5), 482.487. https://doi.org/10.1177/1129729818817248