PMID- 21426513
OWN - NLM
STAT- MEDLINE
DCOM- 20110726
LR  - 20110323
IS  - 1744-9987 (Electronic)
IS  - 1744-9979 (Linking)
VI  - 15
IP  - 2
DP  - 2011 Apr
TI  - Arteriovenous access closure in hemodialysis patients with refractory heart 
      failure: a single center experience.
PG  - 195-202
LID - 10.1111/j.1744-9987.2010.00907.x [doi]
AB  - Arteriovenous dialysis access may impose a burden on the cardiac system. The 
      objective of this study is to examine the usefulness of access closure in 
      hemodialysis patients with refractory heart failure and to identify possible 
      factors associated with symptomatic improvements. The study population comprised 
      33 hemodialysis patients with symptomatic heart failure (New York Heart 
      Association [NYHA] class >/= II), who underwent arteriovenous access closure (30 
      fistulas and three grafts) between 1991 and 2008. In all patients, heart failure 
      was refractory to all possible medical and surgical treatments, and persisted 
      after optimal dry weight control. First, short-term changes in hemodynamics, 
      clinical symptoms and echocardiographic morphology were examined. Second, 
      clinical and echocardiographic parameters were compared between responders 
      (N=23), who demonstrated NYHA class improvement after access closure, and 
      non-responders (N=10). After access closure, systolic blood pressure rose and the 
      heart rate decreased significantly. Body weight and echocardiographic parameters 
      did not change significantly. Twenty-three patients (70%) demonstrated NYHA class 
      improvement and were designated as responders. In responders, the duration from 
      access creation to closure was significantly shorter and fewer had ischemic heart 
      disease, compared with non-responders. Access flow, cardiac output and ejection 
      fraction were comparable between the two groups. Although the five-year survival 
      was 20.2% in all patients, responders showed better early survival than 
      non-responders. Arteriovenous access closure improved clinical symptoms in 70% of 
      patients with refractory heart failure. This improvement was especially likely to 
      be achieved in patients without ischemic heart disease and those who developed 
      heart failure within a relatively short time after access creation.
CI  - (c) 2011 The Authors. Therapeutic Apheresis and Dialysis (c) 2011 International 
      Society for Apheresis.
FAU - Kurita, Noriaki
AU  - Kurita N
AD  - Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital, Tokyo, 
      Japan. kurita_n@opal.plala.or.jp
FAU - Mise, Naobumi
AU  - Mise N
FAU - Tanaka, Shinji
AU  - Tanaka S
FAU - Tanaka, Mototsugu
AU  - Tanaka M
FAU - Sai, Keiko
AU  - Sai K
FAU - Nishi, Takahiro
AU  - Nishi T
FAU - Miura, Sumio
AU  - Miura S
FAU - Kigawa, Ikutaro
AU  - Kigawa I
FAU - Miyairi, Takeshi
AU  - Miyairi T
FAU - Sugimoto, Tokuichiro
AU  - Sugimoto T
LA  - eng
PT  - Journal Article
DEP - 20110220
PL  - Australia
TA  - Ther Apher Dial
JT  - Therapeutic apheresis and dialysis : official peer-reviewed journal of the 
      International Society for Apheresis, the Japanese Society for Apheresis, the 
      Japanese Society for Dialysis Therapy
JID - 101181252
SB  - IM
MH  - Aged
MH  - Arteriovenous Shunt, Surgical/*adverse effects
MH  - Blood Pressure
MH  - Heart Failure/*physiopathology
MH  - Heart Rate
MH  - Humans
MH  - Kidney Diseases/*therapy
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/physiopathology
MH  - Renal Dialysis/adverse effects/*methods
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2011/03/24 06:00
MHDA- 2011/07/27 06:00
CRDT- 2011/03/24 06:00
PHST- 2011/03/24 06:00 [entrez]
PHST- 2011/03/24 06:00 [pubmed]
PHST- 2011/07/27 06:00 [medline]
AID - 10.1111/j.1744-9987.2010.00907.x [doi]
PST - ppublish
SO  - Ther Apher Dial. 2011 Apr;15(2):195-202. doi: 10.1111/j.1744-9987.2010.00907.x. 
      Epub 2011 Feb 20.