Kim Yaeni, Kim Ji-Hye, Woo Juyeon, Choi Oknan, Lee Mina, Choi Sunryoung
Department of Internal Medicine, Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Dialysis Access Center, Sahmyook Medical Center, 82 Mangu-ro, Dongdaemun-gu, Seoul 02500, Republic of Korea.
J Clin Med. 2025 Jun 26;14(13):4556. doi: 10.3390/jcm14134556.
: A vascular access blood flow (Qa) to cardiac output (CO) ratio greater than 0.3 increases the risk of high-output heart failure (HOHF). This study analyzed the characteristics and risk factors associated with a high Qa/CO ratio and effective CO (COef) in these patients over one year. : This prospective study enrolled 142 hemodialysis (HD) patients, divided by the Qa/CO ratio. Baseline and one-year hemodynamics were measured: volume by bioimpedance, CO by echocardiography, Qa and brachial flow by transonic and ultrasound. Risk factors for HOHF were analyzed using receiver operating characteristic (ROC) curves and multivariable regression. : The study population was 66% male, mean age of 65, with 71% using arteriovenous fistulae (AVF) for vascular access. In the high Qa/CO group, cases of younger ages (62 vs. 67 years, = 0.040) with upper arm access (73.1% vs. 32.8%, < 0.001) were more prevalent, and diastolic blood pressure (DBP) was higher (76.8 ± 15.1 vs. 66.7 ± 14.4 mmHg, = 0.002). Independent risk factors for high Qa/CO were elevated DBP (odds ratio [OR]: 1.080; 95% confidence interval [CI]: 1.028-1.134), upper arm access (OR: 8.113; 95% CI: 1.842-35.741), low resistive index (RI) (OR: 0.000; 95% CI: 0.000-0.417), and COef (OR: 0.164; 95% CI: 0.065-0.416). After one year, the high Qa/CO group showed significant increases in CO and COef (4.82 ± 1.25 L/min vs. 6.16 ± 2.05 L/min, = 0.007, and 2.84 ± 0.95 L/min to 4.40 ± 1.89 L/min, 0.001, respectively). A baseline Qa cutoff value of 1.4 L/min demonstrated high diagnostic efficacy in identifying the high Qa/CO group. : High Qa/CO ratios increase overt HOHF risk due to cardiac strain. This study reveals AV access-driven cardiac adaptations in patients with high Qa/CO and low COef, emphasizing the necessity for ongoing clinical and hemodynamic monitoring.
血管通路血流量（Qa）与心输出量（CO）之比大于0.3会增加高输出量心力衰竭（HOHF）的风险。本研究分析了这些患者一年内高Qa/CO比值及有效CO（COef）相关的特征和危险因素。：这项前瞻性研究纳入了142例血液透析（HD）患者，根据Qa/CO比值进行分组。测量了基线和一年时的血流动力学指标：通过生物电阻抗测量血容量，通过超声心动图测量CO，通过跨音速和超声测量Qa及肱动脉血流。使用受试者工作特征（ROC）曲线和多变量回归分析HOHF的危险因素。：研究人群中男性占66%，平均年龄65岁，71%使用动静脉内瘘（AVF）作为血管通路。在高Qa/CO组中，年龄较轻（62岁对67岁，P = 0.040）且采用上臂通路的情况更为普遍（73.1%对32.8%，P < 0.001），舒张压（DBP）更高（76.8±15.1 mmHg对66.7±14.4 mmHg，P = 0.002）。高Qa/CO的独立危险因素包括DBP升高（比值比[OR]：1.080；95%置信区间[CI]：1.028 - 1.134）、上臂通路（OR：8.113；95% CI：1.842 - 35.741）、低阻力指数（RI）（OR：0.000；95% CI：0.000 - 0.417）和COef（OR：0.164；95% CI：0.065 - 0.416）。一年后，高Qa/CO组的CO和COef显著增加（分别为4.82±1.25 L/min对6.16±2.05 L/min，P = 0.007，以及2.84±0.95 L/min至4.40±1.89 L/min，P = 0.001）。基线Qa截断值为1.4 L/min在识别高Qa/CO组方面具有较高的诊断效能。：高Qa/CO比值因心脏负荷增加而增加明显的HOHF风险。本研究揭示了高Qa/CO和低COef患者中AV通路驱动的心脏适应性变化，强调了持续进行临床和血流动力学监测的必要性。
