Abstract: FR-PO781

Changes in Upper Body Blood Flow after AV Fistula Creation in Hemodialysis Patients

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Campos, Israel, Renal Research Institute, Morelia, Michoacán, Mexico
  • Zhang, Hanjie, Renal Research Institute, New York, New York, United States
  • Preciado, Priscila, Renal Research Institute, Morelia, Michoacán, Mexico
  • Thijssen, Stephan, Renal Research Institute, Morelia, Michoacán, Mexico
  • Kotanko, Peter, Renal Research Institute, Morelia, Michoacán, Mexico
Background

Hemodynamic changes occurs after AV fistula (AVF) creation. Cardiovascular adaptive mechanisms allow adequate AVF maturation, usually accompanied by an increase in cardiac output (CO). In hemodialysis (HD) patients with a central-venous catheter (CVC), upper body blood flow (UBBF) can be estimated [Campos et al., WCN 2017]. UBBF is expected to increase after AVF placement in the presence of normal AVF maturation and adequate adaptation

Methods

We estimated UBBF around AVF creation using averaged central-venous oxygen saturation and hemoglobin data from the Crit-Line® Monitor (CLM) (FMC, Waltham, MA) in HD patients from Renal Research Institute clinics. Brain mass was calculated using the Mehrpour formula [J Forensic Leg Med. 2010]. Arm muscle mass was set at 2.3kg for males and 1.2kg for females [Abe T, Br J Sports M. 2003]. Tissue-specific O2 consumption rates were taken from Sokoloff L [Handbook of Physiology. 1960]. Arterial O2 saturation was taken from a large HD population [Meyring-Wösten, CJASN. 2016]. We compared the four closest UBBF values before AVF creation, the first three UBBF estimates after AVF creation and the last three UBBF estimates before first AVF cannulation

Results

We analyzed 12 patients (8 males), mean age 60±12 y. While individual UBBF trajectories differed between patients, UBBF did rise on average after AVF creation (Figure). The average UBBF before and after AVF creation was 1.21±0.03L/min, and 2.15±0.76L/min respectively, and UBBF before the first AVF cannulation was 2.06±0.62L/min

Conclusion

Hemodynamic changes related to AVF creation can be detected non-invasively in HD patients using the CLM. As expected, UBBF increases on average after AVF creation. A prospective study with AVF flow rate measurements alongside UBBF estimation would be insightful and help define the expected UBBF trajectory in well-maturing AVFs