Abstract

Objectives: Diffuse enlargements of arteriovenous dialysis fistulas customarily attributed to either excessive arterial inflow or central outflow stenosis. The relationship between volume status and clinically enlarged (arteriovenous) fistula (CEF) formation in end-stage renal disease (ESRD) patients is not well understood.

Methods: We assessed the pre-dialysis bioimpedance spectroscopy-measured percentage of overhydration (OH%) in 13 prevalent dialysis patients with CEF development and negative angiography and compared the results with those of 52 control dialysis patients (CONTR). All patients were prevalent ESRD patients receiving thrice-weekly maintenance hemodiafiltration at an academic outpatient dialysis unit.

Results: 10/13 CEF patients had OH% ≥15% as compared to 20/52 control patients (Chi square p: .02). The degree of OH% was 20.2 ± 7.4% among the CEF vs. 14.4 ± 7.1% in the control group (Student’s t-test p: .01), representing 4.2 ± 3.2 vs. 2.8 ± 1.6 L of excess fluid pre-dialysis (p: .03). Patients with CEF development took an average of 1.7 ± 1.4 vs. 0.8 ± 0.8 (p: .002) antihypertensive medications compared to the CONTR patients, yet their blood pressure was higher: 156/91 vs. 141/78 mmHg (systolic/diastolic p: .03<.0001). We found no difference in fistula vintage, body mass index, age, diabetes status, or diuretic use. The odds ratio of having a CEF in patients with ≥15% OH status was 5.3 (95% CI: 1.3–21.7; p: .01), the Number Needed to Harm with overhydration was 4.

Conclusions: There is an association between bioimpedance spectroscopy-measured overhydrated clinical state and the presence of CEF; either as an increased volume capacitance or as a potential cause.

Details

Title
The association of overhydration with megafistulas in hemodialysis patients
Author
Tapolyai, Mihály 1 ; Faludi, Mária 2 ; Berta, Klára 2 ; Forró, Melinda 3 ; Zsom, Lajos 4 ; Pethő, Ákos G 5   VIAFID ORCID Logo  ; Rosivall, László 6 ; Fülöp, Tibor 7 

1  Semmelweis University, Budapest, Hungary;; Hemodialysis Unit, Fresenius Medical Care, Budapest, Hungary;; Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA; 
2  Semmelweis University, Budapest, Hungary;; Hemodialysis Unit, Fresenius Medical Care, Budapest, Hungary; 
3  Hemodialysis Unit, Fresenius Medical Care Hungary, Hatvan, Hungary; 
4  Hemodialysis Unit, Fresenius Medical Care Hungary, Cegléd, Hungary; 
5  1st Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary; 
6  Department of Pathophysiology, International Nephrology Research and Training Center, Semmelweis University, Budapest, Hungary; 
7  Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA;; Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA 
Pages
440-445
Publication year
2019
Publication date
Nov 2019
Publisher
Taylor & Francis Ltd.
ISSN
0886022X
e-ISSN
15256049
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1080/0886022X.2019.1614954
ProQuest document ID
2351040763
Copyright
© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This work is licensed under the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.