[Different cardiovascular and hormonal consequences of A-V fistula in uremic patients (author's transl)]. / Differenti conseguenze cardiovascolari ed ormonali della fistola A-V in pazienti uremici.

ABSTRACT

The Authors studied 11 uremic patients for whom it was necessary to make an arterio-venous (A-V) fistula for dialysis purposes. Before and after creation of the fistula, the following parameters were determined arterial pressure (PA) heart rate (HR), peripheral vascular resistances (PVR), renin, adrenalin and nor-adrenalin blood levels. The patients were divided in two groups according to the increase of the systolic output (SO) and o the cardiac index (CI) after the fistula (1st group of 5 patients less than 30% increase of these values as compared to those before the fistula; 2nd group more than 30% increase. By using Wilcoxon distribution free test it was possible to demonstrate the existence of a different condition, statistically significant in the two groups. In the 1st group of older patients (P < 0.05) where the systolic pressure values were greater (P < 0.05) and the indexes of the mechanical events of the left ventricle were altered, there was an increase of heart rate (P < 0.05), a moderate reduction of PVR (P < 0.01) and a very small increase of the systolic output and cardiac index (P < 0.01). Furthermore, in the 1st group, a left ventricular hypertrophy was observed, except in one case whereas this condition was constantly absent in the patients of the 2nd group. Patients of the 1st group had high nor-adrenalin blood levels, which did not change after the significantly after the creation of the fistula. In conclusion, an A-V fistula provokes two different hemodynamic behaviours which are related to age, pressure values, myocardial performance, presence of a left ventricular hypertrophy, PVR variations, and renin and nor-adrenalin blood levels.