title: Renal hemodynamic response to the creation of vascular access in patients with end-stage renal disease.
abstract: To evaluate the possibility that the placement of arteriovenous anastomosis (a/v a) may lead to the attenuation of glomerular hyperfiltration, we studied 5 nondiabetic patients before and after creation of vascular access for hemodialysis. Patients received no EPO and antihypertensive therapy was discontinued 24 h before each study. Cardiac output (CO) and a/v a flow rates were measured by Doppler echo, and GFR and ERPF by plasma decay curves of Tc99m DTPA and 131I-hippuran, respectively. Other parameters were calculated by standard formulas. Augmentation of CO and decrease in systemic vascular resistance occurred in all patients (p = 0.05), yet renal findings were less predictable since only three patients showed a decrease in renal vascular resistance and filtration fraction post a/v a. Thus, there is a discordant pattern of renal hemodynamic response to the creation of a/v a in end-stage renal disease and further studies are needed to better define the subset of patients who are prone to renal vasodilation after the placement of a/v a.
authors.affiliation: Division of Nephrology, National Naval Medical Center, Bethesda, Maryland, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Crowley
authors.forename: R L
authors.initials: RL
authors.lastname: Morrissey
authors.forename: E D
authors.initials: ED
authors.lastname: Silverman
authors.forename: W M
authors.initials: WM
authors.lastname: Yudt
authors.forename: P
authors.initials: P
authors.lastname: Hirszel
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D005919:Glomerular Filtration Rate; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged