Background: Patients with chronic kidney disease (CKD) could present cardiac dysfunction. Recent studies have revealed that advanced CKD at baseline is associated with progressive worsening in cardiac structure and function. Furthermore, the left-to-right shunting of blood through an arteriovenous fistula (AVF) can significantly increase the preload on the heart.
Objectives: To answer for consultations about patients with mid-range ejection fraction (EF :40-50 %), who were candidates for renal dialysis, regarding which access of dialysis is more suitable for such patients and associated with better outcome. Due to a lack of definitive criteria that guide the selection of patients for different access routes, our study tried to identify which access for dialysis (AVF vs Permicath), was associated with better outcome with regard to cardiac function as judged by ejection fraction in such patients.
Patient and Methods: Patients dialyzing with a tunneled cuffed double-lumen central venous catheter (CVC) tend to experience higher rate of infection but less preload on the heart.
Results: In our study, dialysis via AVF & Permicath was associated with marked reduction of the systolic and diastolic blood pressure but no effect on heart rate. AVF significantly improved the LV systolic function but impaired the diastolic function. Permicath associated with significant improvement of LV systolic function with non-significant improvement of diastolic function.
Conclusion: We found that the AV type access contributed to a worsening of the diastolic heart function while permicath provided superior outcomes in patients with both heart failure and ESRD. While clinical guidelines for vascular access recommend avoiding CVC if possible, our findings reappraise the notion that an AVF may not be the optimal approach for each individual. Our study recommends permicath over AVF in patients with significant diastolic dysfunction and markedly dilated heart. Larger studies may be needed, to confirm our results. |
