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

2020 ◽  
pp. 112972982096931
Author(s):  
Jan Malik ◽  
Carlo Lomonte ◽  
Joris Rotmans ◽  
Eva Chytilova ◽  
Ramon Roca-Tey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Vascular Access ◽  
Heart Function ◽  
Clinical Status ◽  
Severe Heart Failure ◽  
Dialysis Patients ◽  
Av Fistula ◽  
Hemodialysis Vascular Access ◽  
Cardiovascular Morbidity And Mortality ◽  
The Individual

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. In PD patients, who need to switch to hemodialysis, vascular access should be created timely. The influence of AV access in patients undergoing cardiac surgery for valvular or ischemic heart disease is also addressed. Cardiovascular implantable electronic devices are increasingly implanted in dialysis patients, but when doing so, the type and location of vascular access should be considered.

scholarly journals Blood Loss through AV Fistula: A Case Report and Literature Review

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Fahad Saeed ◽  
Nadia Kousar ◽  
Ramapriya Sinnakirouchenan ◽  
Vijaya S. Ramalingam ◽  
Philip B. Johnson ◽  
...  
Keyword(s):  
Case Report ◽  
Blood Loss ◽  
Vascular Access ◽  
Blood Transfusions ◽  
Dialysis Access ◽  
Dialysis Catheter ◽  
Acute Blood Loss ◽  
Dialysis Patients ◽  
Av Fistula ◽  
Hemodialysis Vascular Access

Little has been written about acute blood loss from hemodialysis vascular access. We describe a 57-year-old Caucasian male with an approximately 7 gm/dL drop in hemoglobin due to bleeding from a ruptured aneurysm in his right brachiocephalic arteriovenous fistula (AVF). There was no evidence of fistula infection. The patient was successfully managed by blood transfusions and insertion of a tunneled dialysis catheter for dialysis access. Later, the fistula was ligated and a new fistula was constructed in the opposite arm. Aneurysm should be considered in cases of acute vascular access bleeding in chronic dialysis patients.

B-type natriuretic peptide and severe heart failure at baseline predict overall mortality in incident dialysis patients

2010 ◽  
Vol 73 (01) ◽  
pp. 21-29 ◽  
Author(s):  
M. Koch ◽  
R. Trapp ◽  
M. Kohnle ◽  
S. Aker ◽  
B. Haastert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Severe Heart Failure ◽  
Dialysis Patients ◽  
Overall Mortality

Abstract 17736: Cardiomyocyte Specific Loss of Diacylglycerol Acyl Transferase 1 (Dgat1) Reproduces the Abnormalities in Lipids Found in Severe Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Chad M Trent ◽  
Li Liu ◽  
Xiang Fang ◽  
Ni-Huiping Son ◽  
Hongfeng Jiang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Function ◽  
Severe Heart Failure ◽  
Fatty Acid Uptake ◽  
Metabolic Effects ◽  
Acid Uptake ◽  
Acyl Transferase ◽  
Human Heart Failure ◽  
Protein Kinase Cα ◽  
Ceramide Content

Diacylglycerol acyl transferase 1 (DGAT1) catalyzes the final step in triglyceride (TG) synthesis, the conversion of diacylglycerol (DAG) to TG. Dgat1-/- mice exhibit a number of beneficial metabolic effects including reduced obesity and improved insulin sensitivity and no known cardiac dysfunction. In contrast, failing human hearts have severely reduced DGAT1 expression associated with accumulation of DAGs and ceramides. To test whether DGAT1 loss alone affects heart function we created cardiomyocyte specific DGAT1 knockout (hDgat1-/-) mice. hDgat1-/- mice hearts had 95% increased DAG and 85% increased ceramides compared to floxed controls. 50% of these mice died by 9 months of age. The heart failure marker brain natriuretic peptide (Bnp) increased 5-fold in hDgat1-/- hearts and fractional shortening (FS) was reduced. This was associated with a 30% increase in PPARalpha and a 40% increase in Cd36. We crossed hDgat1-/- mice with previously described enterocyte-specific Dgat1 knockout mice (hiDgat1-/-). This corrected the early mortality, improved FS 40%, and reduced cardiac ceramide and DAG content. Treatment of hDgat1-/- mice with GLP-1 receptor agonist exenatide for 1 week reduced Bnp mRNA by 50%, improved FS, and reduced heart DAG and ceramide content by 30-40%. Increased fatty acid uptake into hDgat1-/- hearts was normalized by exenatide. Reduced activity of protein kinase Cα (PKCα), which is known to be increased by DAG and ceramides, paralleled the reductions in these lipids. Our mouse studies show that loss of DGAT1 reproduces the lipid abnormalities seen in severe human heart failure.

Recovery of Heart Function in Children With Acute Severe Heart Failure

2008 ◽  
Vol 85 (7) ◽  
pp. 975-979 ◽  
Author(s):  
John J. OʼSullivan ◽  
Susan L. Roche ◽  
David S. Crossland ◽  
Milind P. Chaudhari ◽  
Richard C. Kirk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Function ◽  
Severe Heart Failure

scholarly journals P1355NEW SURGICAL TECHNIQUE TO CONTROL EXCESS VASCULAR ACCESS BLOOD FLOW

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
KIYOSHI IKEDA
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Cardiac Function ◽  
Vascular Access ◽  
Shortness Of Breath ◽  
Dialysis Patients ◽  
New Device ◽  
Surgical Method ◽  
Patients With Heart Failure ◽  
One Year

Abstract Background and Aims During dialysis, if blood flow rate increases above 1500ml/min. there is an increase in pulsation and a high possibility of heart failure. In the long run, it can cause valvular disease and arrhythmia. In EDTA 2015, we presented a method of blood flow suppression for dialysis patients who had heart failure caused by excessive blood flow. However, within one year, 30% of the cases had relapsed. To solve this problem, we were able to prevent the recurrence of excess blood flow through improvement measures with a new device. Report including theoretical mechanisms. During vascular access excessive shunt blood flow creates a heavy load on cardiac function. Performing blood flow control surgery on dialysis patients with heart failure symptoms improves said function. Depending on the surgical method, it may recur. For this reason, we devised a surgical method that theoretically considers recurrence suppression. Method Clinical symptoms before surgery were based on trial hemodialysis patients with significant arrhythmia and shortness of breath at the time of exertion (6 males 4 females) using EPTFE of 4mm in diameter and 4cm in length or more replaced veins extended from anastomosis. (As shown in Poiseuille's law, it is necessary to replace veins with a shunt of smaller diameter but longer length than the vein being replaced.) The point of insertion at the anastomosis portion of the artery is 4mm. In order to connect to the larger section of the vein to the other end, it is cut diagonally to make the connection secure. During the operation, blood flow was monitored using ultrasound. The central side of the tibia artery was also tied off in some cases to control blood flow. Results Blood flow was reduced to 787 ml/min immediately after surgery from 1970ml/min before surgery, 1007ml after 6 months, and 721 ml/min after one year. Symptoms of arrhythmia disappeared in two patients during surgery and in all cases shortness of breath during exertion disappeared the day after surgery. Cardiac index improved three months after surgery in three cases. In none of the cases did we observe the complete rekindling of blood flow after one year. The average blood flow was less than 63% of the rate before surgery. Conclusion Replacement of 4cm or more length sections of veins with a 4mm diameter graft was useful in improving cardiac function in dialysis patients with heart failure.

scholarly journals Possibilities for the correction of daily blood pressure profile in patients with severe heart failure: A FUTOR (furosemide/torsemide) trial

2009 ◽  
Vol 15 (2) ◽  
pp. 126-131
Author(s):  
M. Bortsova ◽  
M. Y. Sitnikova ◽  
V. V. Dorofeykov ◽  
P. A. Fedotov
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Clinical Status ◽  
Severe Heart Failure ◽  
Pressure Profile ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Blood Pressure Profile ◽  
Β Blockers

Objective. To compare the effect of torasemide (Td) and furosemide (Fd) on the daily blood pressure profile (DBPP), blood pressure (BP) during aclive orthostatic test (OT) and dynamics in brain natriuretic peptide (BNP) levels in patients with heart failure (HF) III-IV (NYHA). Design and methods. 40 patients with stable HF III-IV (NYHA); left ventricular ejection fraction (LVEF) ≤ 40 %; 90 ≤ systolic BP ≤ 140 mmHg; 60 ≤ diastolic BP ≤ 90 mmHg were included. Clinical status, 6-minute walking test (SWT), BNP and aldosterone levels, quality of live (QL), DBPP, OT were assessed. The patients were randomized into two groups: torasemide group TG (n = 20) receiving Td, and furosemide group (FG) (n = 20) receiving Fd. Results. The patients with lower BP during OT and DBPP had higher level of BNP. The low BP levels complicated with drug titration till the recommended doses for HF reatment. We observed the decrease of HF functional class, BNP level, the increased distance in SWT in both groups. TG showed higher BP levels and less BP decrease during OT that allowed us to achieve the highest β-blockers doses and significantly improve QL. Conclusions. 1. Patients with HF with lower BP during DBPP and more expressed decrease of BP in OT had a higher BNP level. 2. The Fd replacement by Td results in the decrease of orthostatic reaction, optimization of SBPP and more significant positive changes in QL. 3. The replacement Fd by Td allows significantly increasing the doses of β-blockers.

scholarly journals Transcatheter Tricuspid Valve-in-Valve Replacement by Transatrial Approach

2020 ◽  
Vol 10 (18) ◽  
pp. 6540
Author(s):  
Grigore Tinica ◽  
Igor Nedelciuc ◽  
Iulian Rotaru ◽  
Flavia Catalina Corciova ◽  
Dumitru Grajdianu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Clinical Status ◽  
Severe Heart Failure ◽  
Late Presentation ◽  
Attractive Alternative ◽  
Novel Approach ◽  
Valve In Valve ◽  
Valve Implantation ◽  
Bioprosthetic Valves

Reoperation on the tricuspid valve after prior heart valve surgery is associated with an increased operative risk due to a poor clinical status with severe heart failure and late presentation. Transcatheter tricuspid valve-in-valve implantation emerged as an attractive alternative to a high-risk redo surgery. The authors report a case of successful treatment of a failed bioprosthetic tricuspid valve in a 58-year-old woman with severe heart failure, decompensated cardiac cirrhosis and atrial fibrillation using transcatheter tricuspid valve-in-valve implantation of a Sapien 3 valve (Edwards Lifesciences, Irvine, California) via a transatrial approach. This case demonstrates the efficiency of this novel approach for the treatment of dysfunctional surgical tricuspid bioprosthetic valves and the technical feasibility and safety of a rarely used route.

scholarly journals New frontiers in vascular access practice: from standardized to patient-tailored care and shared decision making

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0002882021
Author(s):  
Mariana Murea ◽  
Karen Woo
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Vascular Access ◽  
Venous Catheter ◽  
Shared Decision ◽  
Hemodialysis Vascular Access ◽  
Patient Reported ◽  
Kidney Replacement Therapy ◽  
Personalized Approach ◽  
The Individual

Vascular access planning is critical in the management of patients with advanced kidney disease who elect hemodialysis for kidney replacement therapy. Policies put in place more than two decades ago attempted to standardize vascular access care around the model of optimal-i.e, arteriovenous fistula-and least preferred-i.e., central venous catheter-type of access. This homogenized approach to vascular access care emerged ineffective in the ever increasingly heterogeneous and complex dialysis population. The most recent vascular access guidelines acknowledge limitations of standardized care and encourage tailoring vascular access care based on patient and disease characteristics. In this article we discuss available literature in support of patient-tailored access care based on differences in vascular access outcomes by biologic and social factors-age, sex and race. Further, we draw attention to the overlooked dimension of patient-reported preferences and shared decision making in the practice of vascular access planning. We discuss milestones to overcome as requisite steps to implement effective shared decision making in vascular access care. Finally, we take into consideration local practice co-factors as major players in vascular access fate. We conclude that a personalized approach to hemodialysis vascular access will require dynamic care specifically relevant to the individual based on biological factors, fluctuating clinical needs, values and preferences.

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