The effect of haemodialysis access types on cardiac performance and morbidities in patients with symptomatic heart disease
Journal
PLoS ONE
Journal Volume
11
Journal Issue
2
Date Issued
2016
Author(s)
Abstract
Background: Little is known about whether the arteriovenous type haemodialysis access affects cardiac function and whether it is still advantageous to the uremic patient with symptomatic heart disease. Methods: We conducted a retrospective comparative study. Patients with heart disease and endstage renal disease that had a new chronic access created between January 2007 and December 2008 and met the inclusion criteria were assessed. The endpoint was major adverse event (MAE)-free survivals of arteriovenous access (AVA) and tunneled cuffed double-lumen central venous catheter (CVC) groups. Whether accesses worsened heart failure was also evaluated. Results: There were 43 CVC patients and 60 AVA patients. The median follow-up time from access creation was 27.6 months (IQR 34.7, 10.9?45.6). Although CVC patients were older than AVA patients (median age 78.0, IQR 14.0 vs. 67.5, IQR 16.0, respectively, p = .009), they manifested non-inferior MAE-free survival (mean 17.1, 95% CI 10.3?24.0 vs. 12.9, 95% CI 8.5?17.4 months in CVC and AVA patients, respectively, p = .290). During follow-up, more patients in the AVA group than in the CVC group deteriorated in heart failure status (35 of 57 vs. 10 of 42, respectively, odds ratio 5.1, p < .001). Preoperative-postoperative pairwise comparison of echocardiographic scans revealed an increased number of abnormal findings in the AVA group (Z = 3.91, p < .001), but not in the CVC group. Conclusions: In patients with both symptomatic heart disease and end stage renal disease (ESRD), CVC patients showed non-inferior MAE-free survival in comparison to those in the AVA group. AV type access could deteriorate heart failure. Accordingly, uremic patients with symptomatic heart disease are not ideal candidates for AV type access creation. ? 2016 Chuang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
adult; aged; arteriovenous access; Article; central venous catheter; controlled study; deterioration; echocardiography; end stage renal disease; female; follow up; heart disease; heart failure; heart performance; hemodialysis; human; major clinical study; male; morbidity; postoperative period; preoperative period; retrospective study; tunneled cuffed double lumen central venous catheter; adverse effects; complication; diagnostic imaging; echography; heart; Heart Diseases; hemodialysis; Kidney Failure, Chronic; pathophysiology; procedures; prognosis; survival analysis; Aged; Female; Heart; Heart Diseases; Humans; Kidney Failure, Chronic; Male; Morbidity; Postoperative Period; Preoperative Period; Prognosis; Renal Dialysis; Retrospective Studies; Survival Analysis; Ultrasonography
Publisher
Public Library of Science
Type
journal article