Relationship of Vascular Access Flow with Impaired Right Ventricular Function in Chronic Hemodialysis Patients


Background: Cardiovascular events are the leading cause of morbidity and mortality in chronic hemodialysis patients. Impaired right ventricular function is often associated with poor survival in hemodialysis patients. Objective: To determine the effect of vascular access flow (AVFs) of right ventricular function. Methods: This cross-sectional study was done in Department of Nephrology, DMCH during the period January 2020 to July 2021. End stage renal disease patient underwent hemodialysis for ≥3 months were recruited in the study. Patients with chronic respiratory disease, severe valvar heart disease, AVFs flow<200ml/min were excluded. Right ventricular function was assessed by Tricuspid Annular Plane Systolic Excursion (TAPSE) through echocardiography and AVFs blood flow by color duplex study. History for diabetes mellitus, glomerulonephritis and hypertension were retrieved from medical records in addition to variable age and gender. Results of the biochemical variable also retrieved. TAPSE ≤16mm was taken as cut off to characterize subjects as Group I, impaired right ventricular function. Those with >16mm termed as Group II, normal right ventricular function. Data were expressed as mean±SD and number (present) as appropriate. Unpaired student t test, invariable and multivariable analysis were performed as applicable using statistical package for social science (SPSS). p<0.05% was taken as level of significant. Results: Of the total 80 subject 26 constituted Group I and 54 in Group II. Distribution of male and female did not show any statistical association. Distribution of gender in two groups did not show any statistical association. Distribution of the subjects in age cluster was similar in the two groups.

History of DM, GN, and HTN distribution in the two groups was also similar. Duration of hemodialysis (mean±SD) in Group I was 28.04 months and 26.39 months in Group II; two group did not show statistical difference (p=0.529). Systolic blood pressure was 163 mmHg and 160mmHg in Group I and Group II respectively and diastolic blood pressure (mean±SD, mmHg) was 92mmHg and 92mmHg in Group I and Group II respectively; did not statistical difference (p=0.283 and 0.960 respectively). AVFs blood flow 1603±382ml/min (mean±SD,ml/min) in group I was significantly higher compared to the counterpart group II 791±189ml/min. The trend was supported by the significant (p=0.001) inverse relationship between TAPSE and AVFs blood flow. In Group I radio cephalic and brachiocephalic AV fistula distribution was 12 vs 24 (46.2 vs 53.8%) which in the Group II was 51 vs 3(94.4 vs 5.6%). Conclusion: Data concluded that brachiocephalic AVFs lead to significantly higher blood flow than the radio cephalic fistula resulting impaired right ventricular function, which reconfirmed the usefulness of distal AVF as a vascular access in patient for hemodialysis.
 

https://www.stephypublishers.com/tunr/pdf/TUNR.MS.ID.000507.pdf

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