Effects of Arteriovenous Fistula on Blood Pressure in Patients With End‐Stage Renal Disease: A Systematic Meta‐Analysis
Background Central arteriovenous fistula (AVF) creation is under investigation for treatment of severe hypertension. We evaluated the effects of AVF for initiation of hemodialysis on systolic, diastolic, and mean arterial blood pressure in patients with end‐stage renal disease. Methods and Results D...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.011183 |
| _version_ | 1811332290141224960 |
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| author | Sean S. Scholz Davor Vukadinović Lucas Lauder Sebastian Ewen Christian Ukena Raymond R. Townsend Stefan Wagenpfeil Michael Böhm Felix Mahfoud |
| author_facet | Sean S. Scholz Davor Vukadinović Lucas Lauder Sebastian Ewen Christian Ukena Raymond R. Townsend Stefan Wagenpfeil Michael Böhm Felix Mahfoud |
| author_sort | Sean S. Scholz |
| collection | DOAJ |
| description | Background Central arteriovenous fistula (AVF) creation is under investigation for treatment of severe hypertension. We evaluated the effects of AVF for initiation of hemodialysis on systolic, diastolic, and mean arterial blood pressure in patients with end‐stage renal disease. Methods and Results Data search included PubMed, Web of Science, and the Cochrane Library. A systematic review and meta‐analysis of peer‐reviewed studies reporting the effects of the creation/ligation of an AVF on blood pressure in patients with end‐stage renal disease was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analysis), PRISMA‐P (PRISMA for systematic review protocols), and ROBINS‐I (Risk of Bias in Non‐Randomized Studies) criteria by the Cochrane Bias Methods Group. All studies in which the results could have been biased by hemodialysis were excluded. A total of 14 trials including 412 patients with end‐stage renal disease (AVF creation, n=185; AVF ligation, n=227) fulfilled the criteria and were subsequently analyzed. Average blood pressure in patients with no/closed AVF was 140.5/77.6 mm Hg with a mean arterial blood pressure of 96.1 mm Hg. Following creation of AVF, systolic blood pressure significantly decreased by 8.7 mm Hg (P<0.001), diastolic blood pressure by 5.9 mm Hg (P<0.001), and mean arterial blood pressure by 6.6 mm Hg (P=0.02), whereas after ligation systolic blood pressure increased by 5.2 mm Hg (P=0.07), diastolic blood pressure by 3.8 mm Hg (P=0.02), and mean arterial blood pressure by 3.7 mm Hg (P=0.07) during short‐ to long‐term follow‐up. Conclusions Creation of AVF significantly decreases blood pressure in patients with end‐stage renal disease, whereas blood pressure tends to increase after ligation. These findings illustrate the hemodynamic consequences of AVF which are under investigation for severe hypertension. |
| first_indexed | 2024-04-13T16:34:35Z |
| format | Article |
| id | doaj.art-cf5aa05cb75346eaaab7daa87ae82b75 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:34:35Z |
| publishDate | 2019-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-cf5aa05cb75346eaaab7daa87ae82b752022-12-22T02:39:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-02-018410.1161/JAHA.118.011183Effects of Arteriovenous Fistula on Blood Pressure in Patients With End‐Stage Renal Disease: A Systematic Meta‐AnalysisSean S. Scholz0Davor Vukadinović1Lucas Lauder2Sebastian Ewen3Christian Ukena4Raymond R. Townsend5Stefan Wagenpfeil6Michael Böhm7Felix Mahfoud8Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Saarland University Hospital Homburg/Saar GermanyKlinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Saarland University Hospital Homburg/Saar GermanyKlinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Saarland University Hospital Homburg/Saar GermanyKlinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Saarland University Hospital Homburg/Saar GermanyKlinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Saarland University Hospital Homburg/Saar GermanyPerelman School of Medicine University of Pennsylvania Medical Center Philadelphia PAInstitut für Medizinische Biometrie Epidemiologie und Medizinische Informatik (IMBEI) Saarland University Campus Homburg/Saar GermanyKlinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Saarland University Hospital Homburg/Saar GermanyKlinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Saarland University Hospital Homburg/Saar GermanyBackground Central arteriovenous fistula (AVF) creation is under investigation for treatment of severe hypertension. We evaluated the effects of AVF for initiation of hemodialysis on systolic, diastolic, and mean arterial blood pressure in patients with end‐stage renal disease. Methods and Results Data search included PubMed, Web of Science, and the Cochrane Library. A systematic review and meta‐analysis of peer‐reviewed studies reporting the effects of the creation/ligation of an AVF on blood pressure in patients with end‐stage renal disease was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analysis), PRISMA‐P (PRISMA for systematic review protocols), and ROBINS‐I (Risk of Bias in Non‐Randomized Studies) criteria by the Cochrane Bias Methods Group. All studies in which the results could have been biased by hemodialysis were excluded. A total of 14 trials including 412 patients with end‐stage renal disease (AVF creation, n=185; AVF ligation, n=227) fulfilled the criteria and were subsequently analyzed. Average blood pressure in patients with no/closed AVF was 140.5/77.6 mm Hg with a mean arterial blood pressure of 96.1 mm Hg. Following creation of AVF, systolic blood pressure significantly decreased by 8.7 mm Hg (P<0.001), diastolic blood pressure by 5.9 mm Hg (P<0.001), and mean arterial blood pressure by 6.6 mm Hg (P=0.02), whereas after ligation systolic blood pressure increased by 5.2 mm Hg (P=0.07), diastolic blood pressure by 3.8 mm Hg (P=0.02), and mean arterial blood pressure by 3.7 mm Hg (P=0.07) during short‐ to long‐term follow‐up. Conclusions Creation of AVF significantly decreases blood pressure in patients with end‐stage renal disease, whereas blood pressure tends to increase after ligation. These findings illustrate the hemodynamic consequences of AVF which are under investigation for severe hypertension.https://www.ahajournals.org/doi/10.1161/JAHA.118.011183arteriovenous fistulablood pressureend‐stage renal diseasehypertensionshunt |
| spellingShingle | Sean S. Scholz Davor Vukadinović Lucas Lauder Sebastian Ewen Christian Ukena Raymond R. Townsend Stefan Wagenpfeil Michael Böhm Felix Mahfoud Effects of Arteriovenous Fistula on Blood Pressure in Patients With End‐Stage Renal Disease: A Systematic Meta‐Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease arteriovenous fistula blood pressure end‐stage renal disease hypertension shunt |
| title | Effects of Arteriovenous Fistula on Blood Pressure in Patients With End‐Stage Renal Disease: A Systematic Meta‐Analysis |
| title_full | Effects of Arteriovenous Fistula on Blood Pressure in Patients With End‐Stage Renal Disease: A Systematic Meta‐Analysis |
| title_fullStr | Effects of Arteriovenous Fistula on Blood Pressure in Patients With End‐Stage Renal Disease: A Systematic Meta‐Analysis |
| title_full_unstemmed | Effects of Arteriovenous Fistula on Blood Pressure in Patients With End‐Stage Renal Disease: A Systematic Meta‐Analysis |
| title_short | Effects of Arteriovenous Fistula on Blood Pressure in Patients With End‐Stage Renal Disease: A Systematic Meta‐Analysis |
| title_sort | effects of arteriovenous fistula on blood pressure in patients with end stage renal disease a systematic meta analysis |
| topic | arteriovenous fistula blood pressure end‐stage renal disease hypertension shunt |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.011183 |
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