Hemodialysis vascular access affects heart function and outcomes: Tips for choosing the right access for the individual patient.

Hemodialysis vascular access affects heart function and outcomes: Tips for choosing the right access for the individual patient. J Vasc Access. 2020 Nov 04;:1129729820969314 Authors: Malik J, Lomonte C, Rotmans J, Chytilova E, Roca-Tey R, Kusztal M, Grus T, Gallieni M Abstract Chronic kidney disease is associated with increased cardiovascular morbidity and mortality. A well-functioning vascular access is associated with improved survival and among the available types of vascular access the arterio-venous (AV) fistula is the one associated with the best outcomes. However, AV access may affect heart function and, in some patients, could worsen the clinical status. This review article focuses on the specific cardiovascular hemodynamics of dialysis patients and how it is affected by the AV access; the effects of an excessive increase in AV access flow, leading to high-output heart failure; congestive heart failure in CKD patients and the contraindications to AV access; pulmonary hypertension. In severe heart failure, peritoneal dialysis (PD) might be the better choice for cardiac health, but if contraindicated suggestions for vascular access selection are provided based on the individual clinical presentation. Management of the AV access after kidney transplantation is also addressed, considering the cardiovascular benefit of AV access ligation compared to the advantage of having a functioning AVF as backup in case of allograft failure. ...
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research