University Of Tasmania

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Increased excess pressure after creation of an arteriovenous fistula in end stage renal disease

journal contribution
posted on 2023-05-21, 03:10 authored by Pare, M, Goupil, R, Fortier, C, Mac-Way, F, Madore, F, Hametner, B, Wassertheurer, S, Martin SchultzMartin Schultz, James SharmanJames Sharman, Agharazii, M

Background: Reservoir-wave analysis (RWA) separates the arterial waveform into reservoir and excess pressure (XSP) components, where XSP is analogous to flow and related to left ventricular workload. RWA provides more detailed information about the arterial tree than traditional blood pressure (BP) parameters. In end-stage renal disease (ESRD), we have previously shown that XSP is associated with increased mortality and is higher in patients with arteriovenous fistula (AVF). In this study, we examined whether XSP increases after creation of an AVF in ESRD.

Methods: Before and after a mean of 3.9 ± 1.2 months following creation of AVF, carotid pressure waves were recorded using arterial tonometry. XSP and its integral (XSPI) were derived using RWA through pressure wave analysis alone. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (CF-PWV).

Results: In thirty-eight patients (63% male, age 59 ± 15 years), after AVF creation, brachial diastolic BP decreased (79 ± 10 vs 72 ± 12 mmHg, P=0.002), but the reduction in systolic BP, was not statistically significant (133 ± 20 vs 127 ± 26 mmHg, P=0.137). However, carotid XSP (14 [12 - 19] to 17 [12 - 22] mmHg, P=0.031) and XSPI increased significantly (275 [212 - 335] to 334 [241 - 439] kPa∙s, P=0.015), despite a reduction in CF-PWV (13 ± 3.6 vs 12 ± 3.5 m/s, P=0.025).

Conclusion: Creation of an AVF resulted in increased XSP in this population, despite improvement in diastolic BP and aortic stiffness. These findings underline the complex hemodynamic impact of AVF on the cardiovascular system.


Publication title

American Journal of Hypertension




Menzies Institute for Medical Research


Elsevier Science Inc

Place of publication

360 Park Ave South, New York, USA, Ny, 10010-1710

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified