title: Effects of secondary amyloidosis on arteriovenous hemodialysis fistula outcomes and intradialytic hypotension: a case-control study.
abstract: Amyloid fibrils can affect vascular structure through deposition and by causing nitric oxide depletion and increase of asymmetric dimethyl arginine. Patients with amyloidosis are prone to development of hypotension. Hypotension may also affect the maturation of arteriovenous fistula (AVF) and may set the stage for formation of thrombosis and fistula failure. Thus, we aimed to evaluate effects of secondary amyloidosis on AVF outcomes and intradialytic hypotension. This is a case-control study which included 20 hemodialysis patients with amyloidosis and 20 hemodialysis patients without amyloidosis as control group. All patients underwent Doppler ultrasound of AVF. A thorough fistula history and baseline laboratory values along with episodes of intradialytic hypotension and blood pressure measurements were recorded. There was no difference between the groups regarding age, gender, body mass index, presence of comorbidities, hypertension, and drug use. Systolic and diastolic blood pressures were similar (119 ± 28/75 ± 17 and 120 ± 14/75 ± 10 mmHg for patients with and without amyloidosis, respectively). Intradialytic hypotension episodes were also similar. Patients with amyloidosis had significantly lower serum albumin and higher C-reactive protein values compared to control hemodialysis patients. AVF sites and total number of created fistulas were similar in both groups. Flow rates of current functional AVFs were not different between the groups (1084 ± 875 and 845 ± 466 mL/minute for patients with and without amyloidosis, respectively, p:0.67). Patency duration of first AVF was not different between the groups. Clinical fistula outcomes and rate of intradialytic hypotension episodes were not significantly different between patients with and without secondary systemic amyloidosis.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Meram School of Medicine, Selcuk University, Konya, Turkey. yalcinsolakmd@gmail.com
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Solak
authors.forename: Memduh
authors.initials: M
authors.lastname: Caymaz
authors.forename: Halil Zeki
authors.initials: HZ
authors.lastname: Tonbul
authors.forename: Orhan
authors.initials: O
authors.lastname: Ozbek
authors.forename: Kultigin
authors.initials: K
authors.lastname: Turkmen
authors.forename: Niyazi
authors.initials: N
authors.lastname: Gormus
mesh_terms: D000328:Adult; D000686:Amyloidosis / Q000503:physiopathology*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007022:Hypotension / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome