Article (Scientific journals)
The Effect of Elective Ligation of the Arteriovenous Fistula on Cardiac and Renal Functions in Kidney Transplant Recipients.
Masson, Grégoire; Viva, Tommaso; Huart, Justine et al.
2023In Kidney360, 4 (8), p. 1130 - 1138
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Keywords :
Humans; Heart; Renal Dialysis; Kidney/physiology; Kidney Transplantation/adverse effects; Arteriovenous Fistula/surgery; General Earth and Planetary Sciences; General Environmental Science
Abstract :
[en] [en] KEY POINTS: Surgical AVF ligation in KTRs is associated with a significant increase in diastolic BP while systolic BP remains stable. AVF closure in KTRs leads to an improvement of LV and LA morphology and a decrease in serum NT-proBNP levels. There is no significant effect of AVF ligation on kidney allograft function: The eGFR remains stable over time. BACKGROUND: Kidney transplantation is considered as the best kidney replacement therapy, and arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. The systematic ligation of a functioning AVF in stable kidney transplant recipients (KTRs) remains debatable. METHODS: In this prospective study, we investigated the hemodynamic effect of the surgical closure of AVF in KTRs. Forty-three KTRs underwent an ambulatory BP monitoring before surgical closure of AVF (T0) and 12 months later (M12), as well as measurement of serum cardiac biomarkers (i.e., soluble suppression of tumorigenicity 2, N-terminal pro b-type natriuretic peptide [NT-proBNP], and galectin-3). Serum tests were also performed 6 months after AVF closure (M6). An echocardiographic examination was performed at each time point. All serum creatinine values were collected to compare the individual eGFR slopes before versus after AVF closure. The latest measure of the AVF flow before kidney transplantation was recorded. RESULTS: Diastolic BP significantly rose from T0 to M12: +4.4±7.3 mm Hg (P = 0.0003) for 24h, +3.8±7.4 mm Hg (P = 0.0018) during the day, and +6.3±9.9 mm Hg (P = 0.0002) during the night, leading to an increased proportion of KTRs with European Society of Hypertension (ESH)-defined arterial hypertension after AVF ligation. No change was observed for systolic BP. NT-proBNP significantly dropped between T0 and M6 (345 [190; 553] to 230 [118; 458] pg/ml, P = 0.0001) and then remained stable from M6 to M12 while suppression of tumorigenicity 2 and galectin-3 levels did not change from T0 to M12. We observed a significant decrease in left ventricular (LV) end-diastolic volume, LV end-systolic volume, LV mass, interventricular septum diameter, left atrial volume, and tricuspid annular plane systolic excursion from T0 to M6 and then a stability from M6 to M12. LV ejection fraction and eGFR slope remained stable during the whole study. These observations remained unchanged after adjustment for AVF flow. CONCLUSION: The closure of a patent AVF in KTRs is associated with elevation of diastolic BP, drop in serum NT-proBNP levels, reduction of left ventricular and atrial dimensions, and stability of eGFR slope.
Disciplines :
Urology & nephrology
Author, co-author :
Masson, Grégoire ;  Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULiège CHU), Liège, Belgium
Viva, Tommaso ;  Division of Cardiology, Department of Internal Medicine, University of Liège Hospital (ULiège CHU), Liège, Belgium
Huart, Justine  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
Weekers, Laurent  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
BONVOISIN, Catherine ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
Bouquegneau, Antoine  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
MAWEJA, Sylvie ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation
Hamoir, Etienne ;  Université de Liège - ULiège > Département des sciences cliniques
Seidel, Laurence  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des informations médico économiques (SIME)
Pottel, Hans  ;  Université de Liège - ULiège > Département des sciences cliniques ; KU Leuven Kulak, Department of Public Health and Primary Care, University of Leuven, Kortrijk, Belgium
Lancellotti, Patrizio  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie
Jouret, François  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
Language :
English
Title :
The Effect of Elective Ligation of the Arteriovenous Fistula on Cardiac and Renal Functions in Kidney Transplant Recipients.
Publication date :
01 August 2023
Journal title :
Kidney360
eISSN :
2641-7650
Publisher :
Ovid Technologies (Wolters Kluwer Health), United States
Volume :
4
Issue :
8
Pages :
1130 - 1138
Peer reviewed :
Peer reviewed
Available on ORBi :
since 06 October 2023

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