Chronic heart failure, associated with permanent arteriovenous access in patients who are on hemodialysis (diagnostics and monitoring)

Permanent vascular access to the system of circulation is the necessary part with procedures of chronic hemodialysis. Heart failure among a number of complications of arteriovenous access is of the most importance. In the course of the study a comparative analysis of patients’ groups was carried out who were on a chronic hemodialysis with phenomena of heart failure (n=74) and without them (n=88). Examination of these patients comprised Doppler scanning for the zone of arteriovenous fistula, ultrasound cardiography, test of the N-terminal precursor of the brain natriuretic peptide. We determined a dependence of the level of N-terminal precursor of the brain natriuretic peptide in blood of the dialyzed patients from clinical manifestations of heart failure and from data of instrumental methods of its diagnosis. In patients who were on chronic hemodialysis and who had arteriovenous fistula without signs of heart failure the level of N-terminal precursor of the brain natriuretic peptide in blood made 2405 ± 400 Pg/ml average, it is at 6 times higher than referent values in healthy people. With clinical manifestations of heart failure phenomena being confirmed by data of ultrasound (US) cardiography this index made 40620 ± 2450 Pg/ml, that was significantly higher. Correction of the arteriovenous access meant for reduction of the surplus arteriovenous shunt that was confirmed by data of Doppler scanning resulted in regression of heart failure phenomena, improvement of indices of ultrasound cardiography and reliable decrease of the level of N-terminal precursor of the brain natriuretic peptide in blood up to12812 ± 2200 Pg/ml. Thus, monitoring of the concentration of N-terminal precursor of the brain natriuretic peptide in blood of the dialyzed patients allows to diagnosis the heart failure in them, arrange a permanent control of the surplus arteriovenous shunt along a continuous vascular access. In case of necessity it enables to perform in good time the correction of the vascular access aiming at reducing arteriovenous shunt and assessing its efficacy.