RENAL HEMODYNAMIC-RESPONSE TO THE CREATION OF VASCULAR ACCESS IN PATIENTS WITH END-STAGE RENAL-DISEASE

To evaluate the possibility that the placement of arteriovenous anasto mosis (a/v a) may lead to the attenuation of glomerular hyperfiltratio n, we studied 5 nondiabetic patients before and after creation of vasc ular access for hemodialysis. Patients received no EPO and antihyperte nsive therapy was discontinued 24 h before each study. Cardiac output (CO) and a/v a flow rates were measured by Doppler echo, and GFR and E RPF by plasma decay curves of Tc-99m DTPA and I-131-hippuran, respecti vely. Other parameters were calculated by standard formulas. Augmentat ion of CO and decrease in systemic vascular resistance occurred in all patients (p = 0.05), yet renal findings were less predictable since o nly three patients showed a decrease in renal vascular resistance and filtration fraction post a/v a. Thus, there is a discordant pattern of renal hemodynamic response to the creation of a/v a in end-stage rena l disease and further studies are needed to better define the subset o f patients who are prone to renal vasodilation after the placement of a/v a.