PMID- 26663664
OWN - NLM
STAT- MEDLINE
DCOM- 20170720
LR  - 20181202
IS  - 1542-4758 (Electronic)
IS  - 1492-7535 (Linking)
VI  - 20
IP  - 3
DP  - 2016 Jul
TI  - Flow reduction in high-flow arteriovenous fistulas improve cardiovascular 
      parameters and decreases need for hospitalization.
PG  - 362-8
LID - 10.1111/hdi.12387 [doi]
AB  - High output heart failure (HF) and pulmonary hypertension have been demonstrated 
      in patients with prevalent arteriovenous (AV) fistulas. Fistulas with flow >2000 
      mL/minutes are more likely to induce changes in cardiac geometry and pulmonary 
      artery pressure. The effects of reducing flow in AV access and its implications 
      on HF decompensation and hospitalizations have not been studied. Retrospective 
      analysis of 12 patients who needed hospitalization for acute Congestive Heart 
      Failure (CHF) decompensation with AV access flow of 2 L/minutes (as defined by 
      Kidney Disease Outcomes Quality Initiative (KDOQI)) or more were included in the 
      study. All the patients underwent banding of their inflow at the anastomosis with 
      perioperative access flow measurement. Follow-up period was 6 months. 2D echo was 
      done at 6 months postbanding in addition to access flow and clinical evaluation. 
      Complete data was available for all the 12 patients. Study data was collected on 
      all the 12 patients. Mean age was 64.7 years. The mean access flow pre and 
      postbanding were 3784 mL/minutes and 1178 mL/minutes, respectively (P < 0.001). 
      Eighty percent of the patients had diabetes and 41% had coronary artery disease. 
      There was a statistically significant decrease in cardiac output (pre = 7.06 
      L/minutes, post = 6.47 L/minutes P = 0.03), pulmonary systolic pressure (pre = 54 
      mmHg, post = 44 mmHg P = 0.02), left ventricular mass index (LVMI) (pre = 130 
      g/m(2) , post = 125 g/m(2) P = 0.006) and need for rehospitalization for CHF 
      decompensation. The New York Heart Association (NYHA) staging improved by 1 stage 
      postbanding (P = 0.002). The hospitalization rate was 3.75 +/- 1.2 in the 6 months 
      before banding and was decreased to 1.08 +/- 1.2 (P = 0.002) postbanding. The 
      hemoglobin level, predialysis systolic blood pressure, calcium phosphorous 
      product and the use of Renin Angiotensin Aldosterone System (RAAS) blockade 
      agents and calcium channel blockers were comparable before and after inflow 
      banding. Flow reduction in high flow fistulas are associated with decreased LVMI 
      and pulmonary artery pressures. There is also a significant reduction in the risk 
      for hospitalization due to acute HF and an improvement in NYHA heart failure 
      stage.
CI  - (c) 2015 International Society for Hemodialysis.
FAU - Balamuthusamy, Saravanan
AU  - Balamuthusamy S
AD  - Interventional Nephrology Division, Tarrant Vascular Access Center, Fort Worth, 
      Texas, USA.
AD  - Interventional Nephrology Division, Tarrant Nephrology Associates, Fort Worth, 
      Texas, USA.
FAU - Jalandhara, Nishant
AU  - Jalandhara N
AD  - Interventional Nephrology Division, Tarrant Vascular Access Center, Fort Worth, 
      Texas, USA.
AD  - Interventional Nephrology Division, Tarrant Nephrology Associates, Fort Worth, 
      Texas, USA.
FAU - Subramanian, Anand
AU  - Subramanian A
AD  - Interventional Nephrology Division, Tarrant Nephrology Associates, Fort Worth, 
      Texas, USA.
FAU - Mohanaselvan, Arvindselvan
AU  - Mohanaselvan A
AD  - Interventional Nephrology Division, Tarrant Nephrology Associates, Fort Worth, 
      Texas, USA.
LA  - eng
PT  - Journal Article
DEP - 20151214
PL  - Canada
TA  - Hemodial Int
JT  - Hemodialysis international. International Symposium on Home Hemodialysis
JID - 101093910
SB  - IM
MH  - Adult
MH  - Aged
MH  - Arteriovenous Shunt, Surgical/adverse effects/*methods
MH  - Blood Pressure
MH  - Cardiac Output
MH  - Female
MH  - Heart Failure/physiopathology
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Regional Blood Flow
MH  - Retrospective Studies
OTO - NOTNLM
OT  - High flow fistula
OT  - access banding
OT  - flow reduction
OT  - high output cardiac failure
EDAT- 2015/12/15 06:00
MHDA- 2017/07/21 06:00
CRDT- 2015/12/15 06:00
PHST- 2015/12/15 06:00 [entrez]
PHST- 2015/12/15 06:00 [pubmed]
PHST- 2017/07/21 06:00 [medline]
AID - 10.1111/hdi.12387 [doi]
PST - ppublish
SO  - Hemodial Int. 2016 Jul;20(3):362-8. doi: 10.1111/hdi.12387. Epub 2015 Dec 14.