title: Effect of the arteriovenous access for hemodialysis on subendocardial viability ratio, pulse pressure and hospitalizations.
abstract: BACKGROUND
  In some patients the potential benefits of the arteriovenous (AV) access over catheter for hemodialysis seem to be outweighed by global cardiovascular status deterioration.
  
  
  METHODS
  We prospectively evaluated 44 pre-dialysis chronic kidney disease patients submitted to vascular access creation during a follow-up of 25 ± 9 months. We performed pulse wave analysis and biochemical assessment before and 2 months after AV access construction, and we registered premature vascular access thrombosis, and all-cause and cardiovascular hospitalizations throughout follow-up.
  
  
  RESULTS
  We found a statistically significant decrease in the subendocardial viability ratio (SEVR) and pulse pressure (PP) parameters after AV access creation while brain natriuretic peptide significantly increased. Receiver operating characteristic curve analysis identified SEVR ≤113 % evaluated 2 months after vascular access construction as the best cutoff value for predicting all-cause and cardiovascular hospitalizations. Kaplan-Meier analysis showed that a SEVR ≤113 % was associated with all-cause (p = 0.010) and cardiovascular (p = 0.029) hospitalizations; Cox regression analysis verified a 4.9-fold higher risk of all-cause hospitalization in patients with SEVR ≤113 % (p = 0.005).
  
  
  CONCLUSIONS
  To our best knowledge, this report indicates, for the first time, that despite the decrease in PP parameters, the creation of a vascular access for hemodialysis was also associated with a reduction of SEVR which predicted a worse clinical outcome. We argue that the decrease of pulse pressure after arteriovenous construction may reflect a new hemodynamic set-point after vascular access creation and may not indicate a protective cardiovascular effect.
authors.affiliation: Nephrology Department, Hospital Santa Cruz, Avenida Prof. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal, rsenosviz@gmail.com.
authors.forename: Ricardo Senos
authors.initials: RS
authors.lastname: Vizinho
authors.forename: Catarina
authors.initials: C
authors.lastname: Santos
authors.forename: Carlos
authors.initials: C
authors.lastname: Lucas
authors.forename: Teresa
authors.initials: T
authors.lastname: Adragão
authors.forename: José Diogo
authors.initials: JD
authors.lastname: Barata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004699:Endocardium / Q000473:pathology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D014022:Tissue Survival; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers