Vascular access Localization Determines Regional Changes in Arterial Stiffness

Abstract

Background Vascular access (VA) dysfunction is a common cause of hospitalization in chronically hemodialyzed patients (CHP) limiting the improvement in health and has been largely studied in order to decrease the morbidity events that involves both the artery and the vein used in the construction of the fistula. In parallel, patients in end-stage renal failure show an increase in arterial stiffness. Aim The aims of this work were: (a) to evaluate arterial stiffness through pulse wave velocity (PWV) measurements in the carotid-brachial pathway where the arteriovenous fistulae (AVF) was constructed, and (b) to determine possible differences in arterial stiffness between the carotid-brachial pathway with and without VA. Methods PWV, clinical and biochemical parameters were measured in 38 CHP. PWV was obtained in the carotid-femoral, and in the left and right carotid-brachial pathway. Results Carotid-brachial PWV determination in upper limbs with AVF (10.07 ± 2.43 m/s) showed significantly lower values than those observed in the contra-lateral arm without VA (11.55 ± 2.27 m/s). Curiously, the PWV value observed in arms with an AVF was significantly lower in diabetic than in non-diabetic hemodialyzed patients (NDHP) (8.00 ± 2.86 m/s and 10.38 ± 2.33 m/s; respectively). Measurements of PWV in the carotid-femoral pathway in CHP showed a mean value of 14.09 ± 3.12 m/s. Carotid-femoral PWV in NDHP (14.06 ± 2.44 m/s) was significantly lower than that observed in the diabetic patients (16.87 ± 3.42 m/s). Conclusions Carotid-brachial PWV values obtained in the upper limbs, in which VAs were constructed, were significantly lower than that measured in intact arteries in the contra-lateral pathway in CHP.