AVF Volume Blood Flow Reduction in HD Patients

Moscow Regional Research and Clinical Institute (MONIKI)86 enrolled

Overview

Heart failure with preserved / high cardiac output is a well-known syndrome in patients with high-flow arteriovenous fistula (AVF). However, the threshold for classifying an AVF as high-flow is currently undefined. Cardio-fistular recirculation (CFR) is often used as a criterion, with values greater than 25-30% considered cardiotoxic and associated with adverse outcomes. Additionally, CFR is one of the few easily modifiable risk factors through surgical reduction of AVF volume blood flow (Qa). The study aimed to evaluate the extent of involution of heart structural and functional changes following Qa reduction in patients with heart failure and CFR \> 25%.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Chronic Kidney Disease Stage 5 Heart Failure

Eligibility

Sex: ALLMin age: 18 YearsMax age: 100 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Signed informed consent * age \> 18 years * CKD 5D * Native arteriovenous fistula or vascular graft * Heart failure with preserved CO (NYHA I-IV ) * Cardio-fistula recirculation ≥ 25% * eKt/V \> 1.2 * Absence of arrhythmias (except grade I AV block) * Absence of valvular disease (except mitral regurgitation I-II) * Arteriovenous fistula blood flow reduction surgery Exclusion Criteria: * Death * Kidney transplantation * Conversion of vascular access to central venous catheter * Withdrawal of informed consent

Locations (1)

Outcomes

Primary Outcomes

Left ventricular ejection fraction

Time frame: Before and at 6 months after surgery

Estimated pulmonary artery pressure

Time frame: Before and at 6 months after surgery

E/A ratio

Time frame: Before and at 6 months after surgery

Secondary Outcomes

NT-proBNP serum concentration

Time frame: Before and at 6 months after surgery