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Study: Best Outcomes When AVF Flows Restricted to Median Range

avf-flowsA study published in PLOS ONE in March 2017 by clinicians from Huazhong University of Science and Technology in Hubei, China, investigated the association between AVF flows and inflammation, cardiovascular events and deaths in Chinese hemodialysis patients who have a radio-cephalic fistula (AVF). They recognized that AVF flows impact dialysis adequacy in hemodialysis patients. But there was limited data for different access flow levels on outcomes related to long-term dialysis Chinese patients.

Their five-year (2009 to 2015) study of 64 Chinese hemodialysis patients (male, 44; female, 20) followed the link between AVF flows and cardiovascular events and mortality. AVF flow and cardiac output were monitored by the Transonic HD02 Hemodialysis Monitor every six months.

They found:

  • Twenty-three patients (35.9%) developed at least one episode of cardiovascular disease within two years after AVF creation. Forty-one patients did not.
  • The initial flows in the 64 patients ranged from 620 mL/min to 1490 mL/min (mean, 954.5 mL/min).
  • AVF flows were significantly higher in patients with cardiovascular disease than in patients without cardiovascular disease.
  • The independent and strongest risk factor for cardiovascular disease in HD patients was serum IL-6, which demonstrated a positive association with AVF flow levels in patients.
  • Patients with median AVF flows (821.12 mL/min to 1027.13 ml/min) showed the lowest morbidity and mortality due to cardiovascular disease. Patients with higher flows were associated with a higher risk of cardiovascular disease. Patients with AVF flows lower than 600 ml/min had a higher risk of non-cardiovascular disease related death.

The clinicians concluded from their results that keeping AVF flows in a medium range of 821.12 mL/min to 1027.13 ml/min would benefit hemodialysis patients, improve their long-term clinical outcomes and lower AVF-induced inflammation.Download the Hemodialysis Handbook