Abstract: TH-PO771

Changes in Blood Pressures, Adequacy, and Blood and Dialysate Flow Rates before and after Arteriovenous Access Angioplasty

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Han, Hao, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Blanchard, Thomas C, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Zhang, Hanjie, Renal Research Institute, New York, New York, United States
  • Sor, Murat, Fresenius Vascular Care, Malvern, Pennsylvania, United States
  • Koh, Elsie, Fresenius Vascular Care, Malvern, Pennsylvania, United States
  • Jiao, Yue, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Chaudhuri, Sheetal, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Reviriego-Mendoza, Marta, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

Stenosis is a common complication in arteriovenous fistulas and grafts (AVFs/AVGs), and is a major cause of hospitalizations and dialysis access failure. Clinical predictors for early detection of severe stenosis in AVFs/AVGs are sparse. To determine predictors of stenosis, we investigated trends in levels of predialysis systolic and diastolic blood pressures (preSBP/preDBP), dialysis adequacy, blood flow rate (Qb), and dialysate flow rate (Qd) before and after angioplasties in hemodialysis (HD) patients.

Methods

We analyzed data from 7,910 Fresenius Kidney Care HD patients who had an AVF/AVG angioplasty in 2015 and 2016. The preSBP, preDBP, Kt/V, Qb, and Qd were tracked in HD patients for 90 days before and after an angioplasty, and plotted using a penalized B-spline to fit the mean with 95% confidence limits.

Results

During the 90 days prior to an angioplasty, HD patients exhibited a slight decline of approximately 1.5 mmHg in both mean preSBP and preDBP. The most precipitous decline for both preSBP and preDBP was in the final 2 weeks prior to angioplasty. About a week after an angioplasty, mean preSBP and preDBP increased by approximately 1.0 mmHg and 0.5 mmHg, respectively. The preSBP blood pressures at 90 days after an angioplasty were found to decrease by about 0.5 mmHg below the levels seen 2 weeks before an angioplasty. We also observed similar findings for all parameters; specifically, the following changes occurred after angioplasty compared to before angioplasty: i) average Kt/V increased by about 1%; ii) average Qb increased by about 1%; and iii) average Qd increased by approximately 0.5%.

Conclusion

These findings indicate that blood pressures, Kt/V, Qb and Qd decline before and increase after an AVF/AVG stenosis requiring an angioplasty. While individually these are small changes in patient parameters, they can be useful for creation of comprehensive AVF/AVG stenosis prediction models. Nonetheless, further analyses are needed to confirm these observations and assess their usefulness.

Funding

  • Commercial Support