Background It is suggested, that en excessive flow through the arteriovenous fistula is one of the reasons for heart failure among dialised patients. However there is a lack of publications, concerning the influence of a temporary coexistence of two extracorporeal dialysis shunts and the increase of the circulatory failure. As well, among causes of the blood pressure control being worse, an extensive flow through the shunt has not been reported.
The aim of the study was to show the clinical effects, such as worsen of the blood pressure control and the increase in the heart failure, among 5 patients with advanced renal insufficiency and coexisting arterial hypertension. In all cases there was a necessity of creating a second shunt although the primal shunt worked.
Material and methods Five patients, that developed heart failure and worsening of the blood pressure control, after creating a new shunt, participate in the research. Four times, before, 4 and 8 weeks after creating the second shunt and 8 weeks after closing the malfunctioning shunt, these parameters were measured: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, body weight, increase of body weight between dialysis, haematocrit, echocardiography parameters (LVMI and LVDD), inferior caval vein measurement and the blood flow through shunt.
Results Four weeks after creating the second shunt significant increase of SBP appeared and remained despite hypotensive drugs. After closing the malfunctioning shunt the mean systolic blood pressure decreased symptomatically. But the heart rate increased significantly while both shunts were working. No significant changes in DPB were recorded. No body weight changes, increase of body weight between dialysis, inferior caval vein measurement, hemoglobin or haematocrit changes were recorded. LVMI and LVEDD increased significantly after creating the second shunt and normalized after closing the malfunctioning one.
Conclusions 1. Creating a second arteriovenous shunt and leaving the primal shunt temporary may lead to an increase in the heart failure among patients with renal insufficiency, especially with coexisting arterial hypertension. 2. Overload of the cardiovascular system related to excessive blood flow through arteriovenous shunts may lead to an increase in SBP resistant to treatment, but there is no relation to DBP. 3. Postponed closing of the malfunctioning shunt leads to normalization of haemodynamic disorders and clinical symptoms.