Hipertensão pulmonar em pacientes com fístula arteriovenosa para tratamento dialítico: um novo desafio para a cardionefrologia.

Abstract

The Chronic Kidney Disease (CKD) is one of the most relevant clinical entities today, especially due to the increase in its prevalence based on the raise in the life expectancy of the affected population. With the advancement of treatment for end- stage kidney disease (ESKD), comorbidities hitherto unexpected emerged. One of these new complications was Pulmonary Hypertension (PH), a condition classically acquired as a consequence of advanced cardiac and/or pulmonary diseases, but also found in some systemic disorders. Recently, arteriovenous fistula (AVF) has been implicated as one of the probable causes of PH in patients with ESKD. AVF is obtained through a surgical procedure performed in patients with advanced renal disease who undergo hemodialysis (HD) - most used method in Brazil and in the world – such as renal replacement therapy (RRT). This study allows an understanding of the correlation between ESKD, PH and AVF, as well as instigating the debate about prevention and treatment for a devastating complication and which still lacks promising prospects. It is an integrative review, whose first collection resulted in 27 articles; after submission to the inclusion and exclusion criteria, were reduced to 15 articles; after reading the remaining 15, the selection was finalized in 13 articles with the objective of promoting an organized, succinct and reliable analysis of a current topic, which is extremely relevant but, unfortunately, little discussed. The vast majority of the selected articles corroborate the hypothesis that AVF is related to the appearance and/or maintenance of PH in patients with ESKD, since a significantly higher prevalence was found in patients treated through HD than in those who underwent peritoneal dialysis or kidney transplantation – these two RRT modalities do not use AVF. In addition, there was a reduction in pulmonary artery pressure values after the closure of vascular access or reduction of its flow. Given the recent discovery and the known increase in morbimortality that PH causes in patients with ESKD, it is concluded that the understanding of the minutiae of the correlation between ESKD, PH and AVF is fundamental to stimulate and guide the investigation of new forms of prevention and treatment of PH in patients with ESKD, since there is currently no satisfactory data regarding the therapeutic behavior in this context.