ASSIS, A. C. R.; OLIVEIRA, R. R.; http://lattes.cnpq.br/4606984743891704; http://lattes.cnpq.br/6356151052764452; ASSIS, Arthur Cicupira Rodrigues de.; OLIVEIRA, Romário Reis de.
Résumé:
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.