Key result
High arteriovenous fistula flow is linked to ~75% higher left ventricular workload.
Why the study?
The association between vascular access blood flow, cardiac output, and left ventricle load in hemodialysis patients with high access blood flow arteriovenous fistula was investigated.
Does high vascular access blood flow in hemodialysis patients significantly increase the load of the left ventricle compared to lower range flow?
Observational (n=55)
Does high vascular access blood flow in hemodialysis patients significantly increase the load of the left ventricle compared to lower range flow?
Computational modeling suggests that typical ranges of arteriovenous fistula blood flow do not significantly increase left ventricular load in hemodialysis patients.
Answers are grounded in this paper and cite their sources.
High AVF flow was associated with higher LV load; hypothesis-generating and should not yet change vascular access targets in hemodialysis.
The aim of this study was to investigate an association between vascular access blood flow (QVA), cardiac output(CO), and load of left ventricle (LLV) using a simple physical model calculation based on real data, specifically inpatients with high access blood flow arteriovenous fistula(AVF). Vascular access blood flow, CO, and peripheral vascular resistance (PR) were determined by ultrasound dilution technique (HD01; Transonic Systems, Inc., Ithaca, NY). Load of left ventricle was calculated using simplified formula: LLV x PR CO2. This total load was computationally divided into the part spent to run the flow QVA through the AVF (LLVAVF) and that part ensuring the flow (CO-QVA) through the vascular system. The model calculation was first performed in a selected group of 15 patients with high access blood flow (QVA >1,300 ml/min, group 1) and later extended for comparison by another group of 40 unselected patients with access blood flow in lower range (QVA range 200-1,400 ml/min, group 2).Mean LLV in group 1 was 2.10 +/- 0.68 W. LLV(AVF) was 21.8% of total LLV. Mean LLV in group 2 was 1.2 +/- 0.5 W.LLVAVF was 11.1% of total LLV. Our computational results suggest that AVF in typical range of QVA shall not increase heart load significantly.
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Válek et al. (2010) conducted an observational in Hemodialysis (n=55). High access blood flow (QVA >1,300 ml/min) vs. Lower access blood flow (QVA 200-1,400 ml/min) was evaluated on Mean load of left ventricle (LLV). High arteriovenous fistula blood flow (>1,300 ml/min) was associated with a mean left ventricular load of 2.10 W compared to 1.2 W in patients with lower flow.
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