Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function
Objective: Chronic intermittent renal replacement therapy(RRT) is an alternate method of decongestion for patients presenting with diuretic-resistant, end-stage heart failure(HF) and cardiorenal syndrome. The optimal method of vascular access has not been confirmed. This study investigated the 6-mon...
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doaj-c2d2567416b049f6b8a26512eaf0a69e2020-11-24T22:53:40ZengElsevierHellenic Journal of Cardiology1109-96662017-07-0158427628010.1016/j.hjc.2016.11.023Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular functionEvangelos Repasos, MD0Elisabeth Kaldara, MD1Christos Pantsios, MD2Chris Kapelios, MD3Emmeleia Nana, MD4Spiridon Vernadakis, MD5Christina Melexopoulou, MD6Konstantinos Malliaras, MD7John Boletis, MD8John N. Nanas, MD, PhD9Third Department of Cardiology, Athens University School of Medicine, Athens, GreeceThird Department of Cardiology, Athens University School of Medicine, Athens, GreeceThird Department of Cardiology, Athens University School of Medicine, Athens, GreeceThird Department of Cardiology, Athens University School of Medicine, Athens, GreeceThird Department of Cardiology, Athens University School of Medicine, Athens, GreeceTransplantation Unit, Athens University School of Medicine, Laiko General Hospital, Athens, GreeceDepartment of Nephrology and Renal Transplantation, Athens University School of Medicine, Laiko General Hospital, Athens, GreeceThird Department of Cardiology, Athens University School of Medicine, Athens, GreeceDepartment of Nephrology and Renal Transplantation, Athens University School of Medicine, Laiko General Hospital, Athens, GreeceThird Department of Cardiology, Athens University School of Medicine, Athens, GreeceObjective: Chronic intermittent renal replacement therapy(RRT) is an alternate method of decongestion for patients presenting with diuretic-resistant, end-stage heart failure(HF) and cardiorenal syndrome. The optimal method of vascular access has not been confirmed. This study investigated the 6-month outcomes of patients with end-stage HF after the creation of arteriovenous communications (AVC) compared with other means of RRT. Methods: We treated 40 patients with chronic, intermittent, ambulatory RRT, of whom 15 (37.5%; Group A) underwent creation of AVC, and 25 (62.5%; Group B) received intraperitoneal (n=6) or internal jugular catheters (n=19) with the goal of achieving body weight stabilization and relief from congestion. Results: The characteristics of the two groups were similar. According to Cox regression analysis, the 6-month rate of death or re-hospitalization for HF was significantly higher in Group A (73%) than in Group B (44%); hazard ratio (HR): 2.58; 95% confidence interval (CI) 1.2-6.2; P=0.02. Over a 6-month follow-up, the cumulative survival was significantly shorter (P=0.03) in Group A (13.8±10 weeks) than in Group B (20.7±7 weeks). In the 15 patients who received AVC, the only independent predictor of adverse outcome at 6 months was serum total bilirubin concentration (HR 2.5; 95% CI 1.1-5.7, p=0.02), whereas in the 25 patients who underwent other means of RRT, pulmonary vascular resistance (PVR) was identified as a risk factor for hospitalization or death at 1-year follow-up (HR 1.26; 95% CI 1.1-1.57, p=0.04). Conclusion: In patients with end-stage HF, the creation of AVC for intermittent RRT was followed by a significant increase in morbidity and mortality in comparison to the safe and effective placement of permanent central venous catheters. Patients with elevated PVR seem to comprise a group at high risk for adverse outcomes after central catheter insertion.http://www.sciencedirect.com/science/article/pii/S1109966616301804congestive heart failurehigh-output heart failurerenal replacement therapycardiorenal syndromearteriovenous communication |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Evangelos Repasos, MD Elisabeth Kaldara, MD Christos Pantsios, MD Chris Kapelios, MD Emmeleia Nana, MD Spiridon Vernadakis, MD Christina Melexopoulou, MD Konstantinos Malliaras, MD John Boletis, MD John N. Nanas, MD, PhD |
spellingShingle |
Evangelos Repasos, MD Elisabeth Kaldara, MD Christos Pantsios, MD Chris Kapelios, MD Emmeleia Nana, MD Spiridon Vernadakis, MD Christina Melexopoulou, MD Konstantinos Malliaras, MD John Boletis, MD John N. Nanas, MD, PhD Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function Hellenic Journal of Cardiology congestive heart failure high-output heart failure renal replacement therapy cardiorenal syndrome arteriovenous communication |
author_facet |
Evangelos Repasos, MD Elisabeth Kaldara, MD Christos Pantsios, MD Chris Kapelios, MD Emmeleia Nana, MD Spiridon Vernadakis, MD Christina Melexopoulou, MD Konstantinos Malliaras, MD John Boletis, MD John N. Nanas, MD, PhD |
author_sort |
Evangelos Repasos, MD |
title |
Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function |
title_short |
Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function |
title_full |
Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function |
title_fullStr |
Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function |
title_full_unstemmed |
Arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function |
title_sort |
arteriovenous renal replacement therapy in end-stage left-sided heart failure patients has a detrimental effect on patients with impaired right ventricular function |
publisher |
Elsevier |
series |
Hellenic Journal of Cardiology |
issn |
1109-9666 |
publishDate |
2017-07-01 |
description |
Objective: Chronic intermittent renal replacement therapy(RRT) is an alternate method of decongestion for patients presenting with diuretic-resistant, end-stage heart failure(HF) and cardiorenal syndrome. The optimal method of vascular access has not been confirmed. This study investigated the 6-month outcomes of patients with end-stage HF after the creation of arteriovenous communications (AVC) compared with other means of RRT.
Methods: We treated 40 patients with chronic, intermittent, ambulatory RRT, of whom 15 (37.5%; Group A) underwent creation of AVC, and 25 (62.5%; Group B) received intraperitoneal (n=6) or internal jugular catheters (n=19) with the goal of achieving body weight stabilization and relief from congestion.
Results: The characteristics of the two groups were similar. According to Cox regression analysis, the 6-month rate of death or re-hospitalization for HF was significantly higher in Group A (73%) than in Group B (44%); hazard ratio (HR): 2.58; 95% confidence interval (CI) 1.2-6.2; P=0.02. Over a 6-month follow-up, the cumulative survival was significantly shorter (P=0.03) in Group A (13.8±10 weeks) than in Group B (20.7±7 weeks). In the 15 patients who received AVC, the only independent predictor of adverse outcome at 6 months was serum total bilirubin concentration (HR 2.5; 95% CI 1.1-5.7, p=0.02), whereas in the 25 patients who underwent other means of RRT, pulmonary vascular resistance (PVR) was identified as a risk factor for hospitalization or death at 1-year follow-up (HR 1.26; 95% CI 1.1-1.57, p=0.04).
Conclusion: In patients with end-stage HF, the creation of AVC for intermittent RRT was followed by a significant increase in morbidity and mortality in comparison to the safe and effective placement of permanent central venous catheters. Patients with elevated PVR seem to comprise a group at high risk for adverse outcomes after central catheter insertion. |
topic |
congestive heart failure high-output heart failure renal replacement therapy cardiorenal syndrome arteriovenous communication |
url |
http://www.sciencedirect.com/science/article/pii/S1109966616301804 |
work_keys_str_mv |
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