Effects of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients
| العنوان: | Effects of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients |
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| المؤلفون: | Robert P. Carroll, Ewan Macaulay, Adil Rajwani, P. Toby Coates, Karen S.L. Teo, Stephen P. McDonald, Santosh A. Olakkengil, Shahid Ullah, David R. King, Nitesh N. Rao, Michael B. Stokes, Matthew I. Worthley, Randall J. Faull, Christine Russell, Kerry Williams |
| المصدر: | Circulation. 139:2809-2818 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, Time Factors, 030232 urology & nephrology, Arteriovenous fistula, 030204 cardiovascular system & hematology, Kidney transplant, Ventricular Function, Left, 03 medical and health sciences, Arteriovenous Shunt, Surgical, 0302 clinical medicine, Renal Dialysis, Physiology (medical), Internal medicine, Natriuretic Peptide, Brain, South Australia, medicine, Humans, Cardiac structure, Prospective Studies, Ligation, Kidney transplantation, Aged, Ventricular Remodeling, medicine.diagnostic_test, business.industry, Hemodynamics, Stroke Volume, Magnetic resonance imaging, Recovery of Function, Middle Aged, medicine.disease, Kidney Transplantation, Magnetic Resonance Imaging, Peptide Fragments, Transplantation, Treatment Outcome, Cardiology, Kidney Failure, Chronic, Female, Hypertrophy, Left Ventricular, Cardiology and Cardiovascular Medicine, business, Biomarkers, Glomerular Filtration Rate |
| الوصف: | Background: Cardiovascular morbidity and mortality remain high in recipients of a kidney transplant. The persistence of a patent arteriovenous fistula (AVF) after transplantation may contribute to ongoing maladaptive cardiovascular remodeling. The ability to reverse this maladaptive remodeling by ligation of this AVF is unknown. We conducted the first randomized controlled trial to evaluate the effect of AVF ligation on cardiac structure and function in stable kidney transplant recipients. Methods: In this randomized controlled trial, kidney transplant recipients (>12 months after transplantation with stable graft function) were randomized to AVF ligation or no intervention. All participants underwent cardiac magnetic resonance imaging at baseline and at 6 months. The primary outcome was the change in left ventricular (LV) mass. Secondary outcomes included changes in LV volumes, left and right atrial areas, LV ejection fraction, NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, cardiac output/index, brachial flows (ipsilateral to AVF), and pulmonary artery velocity. Results: A total of 93 patients were screened, of whom 64 met the inclusion criteria and were randomized to the AVF ligation (n=33) or control (n=31) group. Fifty-four participants completed the study: 27 in the AVF ligation group and 27 in the control group. On the second cardiac magnetic resonance scan, a mean decrease of 22.1 g (95% CI, 15.0–29.1) was observed in LV mass in the AVF ligation group compared with a small increase of 1.2 g (95% CI, −4.8 to 7.2) in the control group ( P P P =0.93) and pulmonary artery velocity ( P =0.07). No significant complications were noted after AVF ligation. No changes in estimated glomerular filtration rate or systolic and diastolic blood pressures were observed between cardiac magnetic resonance scans. Conclusions: Elective ligation of patent AVF in adults with stable kidney transplant function resulted in clinically significant reduction of LV myocardial mass. Clinical Trial Registration: Australian and New Zealand Clinical Trials Registry URL: https://www.anzctr.org.au . Unique Identifier: ACTRN12613001302741. |
| تدمد: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circulationaha.118.038505 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8144632da07607569d121a51af26b7c6 https://doi.org/10.1161/circulationaha.118.038505 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....8144632da07607569d121a51af26b7c6 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15244539 00097322 |
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| DOI: | 10.1161/circulationaha.118.038505 |