Effect of preoperative heart failure on arteriovenous access patency and prognosis in patients on hemodialysis.

IF 1.7 3区医学 Q3 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Access Pub Date : 2025-09-01 Epub Date: 2024-10-24 DOI:10.1177/11297298241282269

Youngjin Han, Eol Choi

{"title":"Effect of preoperative heart failure on arteriovenous access patency and prognosis in patients on hemodialysis.","authors":"Youngjin Han, Eol Choi","doi":"10.1177/11297298241282269","DOIUrl":null,"url":null,"abstract":"Background: The risk of arteriovenous (AV) access failure is associated with hemodynamic factors, clinical factors, or technical issues. Although several studies have shown the detrimental effects of AV access on heart function, few studies have assessed whether heart function affects AV access patency. We investigated the impact of cardiac function on AV access patency. Additionally, we evaluated the influence of heart failure (HF) on the prognosis of patients on dialysis.Methods: Patients who underwent dialysis and had echocardiographic reports between 2011 and 2013 were retrospectively included. Left ventricular ejection fraction (LVEF) was used to measure cardiac function. Data on demographics, clinical features, and technical factors associated with AV access surgery were collected. Univariate and multivariate analyses were performed to evaluate the risk factors for AV access patency loss and the prognosis of patients on dialysis.Results: During the study period, 395 patients initiated on dialysis underwent echocardiography. In multivariate analysis, older age (hazard ratio (HR) 1.02 (1-1.03), p = 0.028), smoking (HR 2.05 (1.19-3.53), p = 0.01), lower LVEF (HR 0.98 (0.97-1), p = 0.015), and graft use (HR 2.29 (1.47-3.58), p = 0.001) were significant risk factors for primary patency loss. Regarding secondary patency loss, lower LVEF (HR 0.98 (0.96-1), p = 0.035) was the sole risk factor. In multivariate analysis, risk factors for cardiac events (acute coronary syndrome and aggravation of HF) in patients on dialysis were age (HR 1.06 (1.04-1.09), p = 0.001), diabetes (HR 2.46 (1.31-4.63), p = 0.005), pre-existing coronary artery disease (HR 2.84 (1.57-5.14), p = 0.001), and HF (HR 1.93 (1.05-3.56), p = 0.036).Conclusion: Decreased cardiac function adversely affects the primary and secondary patency of AV access, but its impact is limited. Additionally, HF is associated with future cardiac events in dialysis patients. However, HF is not independently associated with patient survival.","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"1569-1576"},"PeriodicalIF":1.7000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Vascular Access","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/11297298241282269","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/24 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The risk of arteriovenous (AV) access failure is associated with hemodynamic factors, clinical factors, or technical issues. Although several studies have shown the detrimental effects of AV access on heart function, few studies have assessed whether heart function affects AV access patency. We investigated the impact of cardiac function on AV access patency. Additionally, we evaluated the influence of heart failure (HF) on the prognosis of patients on dialysis.

Methods: Patients who underwent dialysis and had echocardiographic reports between 2011 and 2013 were retrospectively included. Left ventricular ejection fraction (LVEF) was used to measure cardiac function. Data on demographics, clinical features, and technical factors associated with AV access surgery were collected. Univariate and multivariate analyses were performed to evaluate the risk factors for AV access patency loss and the prognosis of patients on dialysis.

Results: During the study period, 395 patients initiated on dialysis underwent echocardiography. In multivariate analysis, older age (hazard ratio (HR) 1.02 (1-1.03), p = 0.028), smoking (HR 2.05 (1.19-3.53), p = 0.01), lower LVEF (HR 0.98 (0.97-1), p = 0.015), and graft use (HR 2.29 (1.47-3.58), p = 0.001) were significant risk factors for primary patency loss. Regarding secondary patency loss, lower LVEF (HR 0.98 (0.96-1), p = 0.035) was the sole risk factor. In multivariate analysis, risk factors for cardiac events (acute coronary syndrome and aggravation of HF) in patients on dialysis were age (HR 1.06 (1.04-1.09), p = 0.001), diabetes (HR 2.46 (1.31-4.63), p = 0.005), pre-existing coronary artery disease (HR 2.84 (1.57-5.14), p = 0.001), and HF (HR 1.93 (1.05-3.56), p = 0.036).

Conclusion: Decreased cardiac function adversely affects the primary and secondary patency of AV access, but its impact is limited. Additionally, HF is associated with future cardiac events in dialysis patients. However, HF is not independently associated with patient survival.

查看原文本刊更多论文

术前心力衰竭对血液透析患者动静脉通路通畅性和预后的影响。

背景：动静脉（AV）通路失败的风险与血液动力学因素、临床因素或技术问题有关。尽管多项研究表明动静脉通路对心脏功能有不利影响，但很少有研究评估心脏功能是否会影响动静脉通路的通畅性。我们研究了心脏功能对房室通路通畅性的影响。此外，我们还评估了心力衰竭（HF）对透析患者预后的影响：方法：回顾性纳入 2011 年至 2013 年期间接受透析且有超声心动图报告的患者。左心室射血分数（LVEF）用于测量心脏功能。收集了与房室通路手术相关的人口统计学、临床特征和技术因素的数据。研究人员进行了单变量和多变量分析，以评估房室通路通畅性丧失的风险因素和透析患者的预后：研究期间，395 名开始透析的患者接受了超声心动图检查。在多变量分析中，年龄较大（危险比 (HR) 1.02 (1-1.03)，p = 0.028）、吸烟（HR 2.05 (1.19-3.53)，p = 0.01）、LVEF 较低（HR 0.98 (0.97-1)，p = 0.015）和使用移植物（HR 2.29 (1.47-3.58)，p = 0.001）是一次通畅性丧失的重要危险因素。在继发性通畅损失方面，较低的 LVEF（HR 0.98 (0.96-1)，p = 0.035）是唯一的风险因素。在多变量分析中，透析患者发生心脏事件（急性冠状动脉综合征和高血压恶化）的危险因素是年龄（HR 1.06 (1.04-1.09)，P = 0.001）、糖尿病（HR 2.46 (1.31-4.63)，P = 0.005）、原有冠状动脉疾病（HR 2.84 (1.57-5.14)，P = 0.001）和 HF（HR 1.93 (1.05-3.56)，P = 0.036）：结论：心功能减退会对房室通路的一次和二次通畅性产生不利影响，但影响有限。此外，心房颤动与透析患者未来的心脏事件有关。然而，心房颤动与患者的存活率无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Vascular Access 医学-外周血管病

CiteScore

3.40

自引率

31.60%

发文量

181

审稿时长

6-12 weeks

期刊介绍： The Journal of Vascular Access (JVA) is issued six times per year; it considers the publication of original manuscripts dealing with clinical and laboratory investigations in the fast growing field of vascular access. In addition reviews, case reports and clinical trials are welcome, as well as papers dedicated to more practical aspects covering new devices and techniques. All contributions, coming from all over the world, undergo the peer-review process. The Journal of Vascular Access is divided into independent sections, each led by Editors of the highest scientific level: • Dialysis • Oncology • Interventional radiology • Nutrition • Nursing • Intensive care Correspondence related to published papers is also welcome.