Malik Jan, Kudlicka Jaroslav, Tesar Vladimir, Linhart Ales
3rd Department of Internal Medicine, First Faculty of Medicine, Charles University Prague, Prague, Czech Republic.
Contrib Nephrol. 2015;184:75-86. doi: 10.1159/000365499. Epub 2015 Feb 9.
More than 50% of all end-stage renal disease (ESRD) patients die from cardiovascular complications. Among them, heart failure and pulmonary hypertension play a major role, and published studies document significantly higher mortality rates in patients with these two states. Arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) are the preferred types of vascular access (VA). However, both AVF and AVG increase cardiac output and in turn could contribute to (the decompensation of) heart failure or pulmonary hypertension. No really safe access flow volume exists, and the ESRD patients' reactions to it vary considerably. We review the mechanisms involved in the cardiovascular consequences of increased cardiac output and available literary data. The link between access flow volume and increased mortality due to pulmonary hypertension or heart failure probably exists, but still has not been directly evidenced. Regular echocardiography is advisable especially in patients with symptoms or with high VA flow (>1,500 ml/min).
超过50%的终末期肾病（ESRD）患者死于心血管并发症。其中，心力衰竭和肺动脉高压起主要作用，已发表的研究表明，患有这两种疾病的患者死亡率显著更高。动静脉内瘘（AVF）和动静脉移植物（AVG）是血管通路（VA）的首选类型。然而，AVF和AVG都会增加心输出量，进而可能导致心力衰竭或肺动脉高压（失代偿）。不存在真正安全的通路血流量，ESRD患者对此的反应差异很大。我们回顾了心输出量增加的心血管后果所涉及的机制以及现有的文献数据。通路血流量与因肺动脉高压或心力衰竭导致的死亡率增加之间可能存在联系，但仍未得到直接证实。尤其是对于有症状或VA血流量高（>1500 ml/分钟）的患者，建议定期进行超声心动图检查。
