Chang TI, Paik J, Greene T et al. J Am Soc Nephrol 2011;22:1526–33.
The authors of the present study assessed whether an increased frequency of intradialytic hypotension, lower pre-dialytic blood pressure levels, or more frequent episodes of large-volume ultrafiltration are associated with higher rates of vascular access thrombosis. The present study included 1426 hemodialysis patients who were followed for a median time of 3.1 years. The authors found that intradialytic hypotension was associated with arteriovenous fistula thrombosis but not with prosthetic graft in patients on hemodialysis. Furthermore, lower blood pressure levels either pre- or post-dialysis were associated with a higher rate of vascular access thrombosis irrespective of the type of access. The frequency of large-volume ultrafiltration sessions was not associated with increased rate of vascular access thrombosis.
Thrombosis is the most common cause of secondary vascular access failure. Among various factors, low flow states secondary to low blood pressure (BP) levels and hemoconcentration secondary to large volume ultrafiltration have been proposed to precipitate vascular access thrombosis. The present study investigated whether increased frequencies of intradialytic hypotension, lower pre-dialytic BP levels, or large-volume ultrafiltration are associated with higher rates of vascular access thrombosis.