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Comparative Study
. 2019 Aug 14;32(9):858-867.
doi: 10.1093/ajh/hpz081.

Effect of Arteriovenous Fistula Creation on Systolic and Diastolic Blood Pressure in Patients With Pre-dialysis Advanced Chronic Kidney Disease

Roy O Mathew  1 , Jerome Fleg  2 , Janani Rangaswami  3 , Bo Cai  4 , Arif Asif  5 , Mandeep S Sidhu  6 , Sripal Bangalore  7
Affiliations
Comparative Study

Effect of Arteriovenous Fistula Creation on Systolic and Diastolic Blood Pressure in Patients With Pre-dialysis Advanced Chronic Kidney Disease

Roy O Mathew et al. Am J Hypertens. .

Abstract

Background: Central arteriovenous fistula (cAVF) has been investigated as a therapeutic measure for treatment-resistant hypertension in patients without advanced chronic kidney disease (CKD). There is considerable experience with the use of AVF for hemodialysis in patients with end-stage renal disease (ESRD). However, there is sparse data on the blood pressure (BP) effects of an AVF among patients with ESRD. We hypothesized that AVF creation would significantly reduce BP compared with patients who did not have an AVF among patients with ESRD before starting hemodialysis.

Methods: BPs were compared during the 12 months before hemodialysis initiation in 399 patients with an AVF or AV graft created and 4,696 patients without either.

Results: After propensity score matching 1:2 ratio (AVF to no AVF), repeated measures analysis of variance revealed significant reductions of -1.7 mm Hg systolic and -3.9 mm Hg diastolic BP 12 months in patients after AVF creation; P = 0.025 and P < 0.001, respectively, compared with those with no AVF.

Conclusions: These findings suggest that AVF creation results in modest BP reduction in patients with pre-dialysis ESRD who require AVF for eventual hemodialysis therapy. Preferential diastolic BP reduction suggests that greater work is needed to characterize the ideal patient subset in which to use cAVF for treatment-resistant hypertension in those without advanced CKD.

Keywords: arteriovenous fistula; blood pressure; central arteriovenous fistula; chronic kidney disease; hypertension; therapeutics; treatment-resistant hypertension.

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Figures

Figure 1.
Figure 1.
Flow diagram for patient selection. Abbreviations: AVF, arteriovenous fistula; AVG, arteriovenous graft; BP, blood pressure; CKD, chronic kidney disease; USRDS, United States Renal Data Service.
Figure 2.
Figure 2.
Timing of blood pressure measurements in the AVFAVG and catheter cohorts. Abbreviations: AVF, arteriovenous fistula; AVG, arteriovenous graft.
Figures 3. (a–c)
Figures 3. (a–c)
Systolic blood pressure, diastolic blood pressure, and heart rate changes over the 12-month observation period.
See this image and copyright information in PMC

Comment in

References

    1. Carey RM, Sakhuja S, Calhoun DA, Whelton PK, Muntner P. Prevalence of apparent treatment-resistant hypertension in the United States. Hypertension 2019; 73:424–431. - PMC - PubMed
    1. Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, Egan BM, Flack JM, Gidding SS, Judd E, Lackland DT, Laffer CL, Newton-Cheh C, Smith SM, Taler SJ, Textor SC, Turan TN, White WB; American Heart Association Professional/Public Education and Publications Committee of the Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Genomic and Precision Medicine; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension 2018; 72:e53–e90. - PMC - PubMed
    1. Braam B, Taler SJ, Rahman M, Fillaus JA, Greco BA, Forman JP, Reisin E, Cohen DL, Saklayen MG, Hedayati SS. Recognition and management of resistant hypertension. Clin J Am Soc Nephrol 2017; 12:524–535. - PMC - PubMed
    1. Thomas G, Xie D, Chen HY, Anderson AH, Appel LJ, Bodana S, Brecklin CS, Drawz P, Flack JM, Miller ER III, Steigerwalt SP, Townsend RR, Weir MR, Wright JT Jr, Rahman M; CRIC Study Investigators Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: report from the chronic renal insufficiency cohort study. Hypertension 2016; 67:387–396. - PMC - PubMed
    1. Bertog SC, Sobotka NA, Sobotka PA, Lobo MD, Sievert K, Vaskelyte L, Sievert H, Schmieder RE. Percutaneous creation of a Central Iliac arteriovenous anastomosis for the treatment of arterial hypertension. Curr Hypertens Rep 2018; 20:18. - PubMed

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