Impact of pulmonary hypertension on arteriovenous fistula failure of hemodialysis patients: A 10 years follow-up cohort study

Li Song; Zi-Lin Quan; Li-Yan Zhao; Dong-Mei Cui; Mi Zhong; Li-Fang Zhou; Chun-Yan Sun; Ying-Gui Chen; Ya-Wen Mo; Zhonglin Feng; Yiming Tao; Zhiming Ye; Yuanhan Chen; Huaban Liang; Ting Lin; Shuangxin Liu; Xin-Ling Liang; Xia Fu

doi:10.1177/11297298211027408

Impact of pulmonary hypertension on arteriovenous fistula failure of hemodialysis patients: A 10 years follow-up cohort study

J Vasc Access. 2023 Mar;24(2):261-270. doi: 10.1177/11297298211027408. Epub 2021 Jul 6.

Authors

Li Song¹, Zi-Lin Quan¹, Li-Yan Zhao¹, Dong-Mei Cui¹, Mi Zhong¹, Li-Fang Zhou^{1

2}, Chun-Yan Sun^{1

2}, Ying-Gui Chen^{1

2}, Ya-Wen Mo³, Zhonglin Feng¹, Yiming Tao¹, Zhiming Ye¹, Yuanhan Chen¹, Huaban Liang¹, Ting Lin¹, Shuangxin Liu¹, Xin-Ling Liang¹, Xia Fu^{1

2

4}

Affiliations

¹ Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² School of Nursing, Southern Medical University, Guangzhou, China.
³ StateKey Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
⁴ ShanTou University Medical College, Shantou, China.

PMID: 34227421
DOI: 10.1177/11297298211027408

Abstract

Background: Pulmonary hypertension (PH) is common in patients with end-stage renal disease (ESRD). Arteriovenous fistulas (AVF) creation may involve in the pathogenesis of PH. The aim of this study was to explore the impact of PH after AVF creation on the AVF failure rate in maintenance hemodialysis (MHD) patients.

Methods: From January 1, 2009, to January 1, 2019, we retrospectively collected data of 578 MHD patients in Guangdong Provincial People's Hospital Blood Purification Center, China. Patients were followed-up until AVF failure or death or May 25, 2020. According to the systolic pulmonary artery pressure (SPAP) within 1 year after the establishment of AVF, the MHD patients were divided into three groups: SPAP ⩽ 35 mmHg, 35 < SPAP < 45 mmHg, SPAP ⩾ 45 mmHg. The primary outcome was AVF failure defined as AVF cannot complete hemodialysis. The secondary outcomes were all-cause mortality.

Results: A total of 578 patients were analyzed. The average age was 60.66 ± 15.34 years (58.1% men). Of these, 26.1% of patients were reported PH. The SPAP exhibited a left-skewed nonparametric distribution and the overall SPAP after the creation of AVF was 39.00 (29.00-52.00) mmHg. The median follow-up was 5.8 (5.5-6.3) years. Overall, 12.8% (74/578) patients were reported AVF failure events. There was no significant difference in AVF failure rate among three groups (p = 0.070). A total of 111 (19.2%) died during the follow-up period. Compared with the SPAP ⩽35 mmHg group, only the all-cause death rate significantly increased in MHD patients with PH (p < 0.001).

Conclusions: The secondary pulmonary hypertension after AVF creation did not increase the risk of AVF failure in MHD patients, but significantly increased the risk of mortality for this portion of the patients. Future larger sample sizes, multi-center, and prospective trials are needed to make sure which type of access will benefit on their survival for MHD patients with SPAP ⩾35 mmHg.

Keywords: Hemodialysis; arteriovenous fistula; pulmonary hypertension; systolic pulmonary artery pressure.

MeSH terms

Aged
Arteriovenous Shunt, Surgical* / adverse effects
Female
Follow-Up Studies
Humans
Hypertension, Pulmonary* / complications
Hypertension, Pulmonary* / etiology
Kidney Failure, Chronic* / complications
Kidney Failure, Chronic* / diagnosis
Kidney Failure, Chronic* / therapy
Male
Middle Aged
Prospective Studies
Renal Dialysis / adverse effects
Retrospective Studies