The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study

Abstract

Aim: Arteriovenous fistula-formation remains critical for the provision of hemodialysis in endstage renal failure patients. Its creation results in a significant increase in cardiac output, with resultant alterations in cardiac stroke volume, systemic blood flow, and vascular resistance. The impact of fistula-formation on cardiac and vascular structure and function has not yet been evaluated via "gold standard" imaging techniques in the modern era of end-stage renal failure care. Methods: A total of 24 patients with stage 5 chronic kidney disease undergoing fistula-creation were studied in a single-arm pilot study. Cardiovascular magnetic resonance imaging was undertaken at baseline, and prior to and 6 months following fistula-creation. This gold standard imaging modality was used to evaluate, via standard brachial flow-mediated techniques, cardiac structure and function, aortic distensibility, and endothelial function. , and left ventricular mass were observed (12.7% increase) (P,0.01). Endothelial-dependent vasodilation was significantly decreased at follow up (9.0%±9% vs 3.0%±6%) (P=0.01). No significant change in aortic distensibility was identified. Conclusion:In patients with end-stage renal failure, fistula-formation is associated with an increase in cardiac output, dilation of all cardiac chambers and deterioration in endothelial function.

Controversies in the management of the haemodialysis-related arteriovenous fistula following kidney transplantation

“…In contrast, AVF creation was associated with significant right ventricle (RV) dilatation and deterioration in RV function. Similar observations were reported in a longitudinal series including 24 ESRD patients [45]. Sequential cardiac magnetic resonance imaging (MRI) showed significant increases in LV and RV end-systolic volumes, left and right atrial area and LV mass following AVF creation.…”

High Output Heart Failure Associated With Arteriovenous Fistula in the Setting of Kidney Transplantation

“…The increased venous return increases right atrial, pulmonary artery, and LV enddiastolic volumes, causing LV hypertrophy as a result of the increased workload. 1 Increased LV mass is linked to higher cardiovascular morbidity and mortality. 2 Additionally, reduced systemic vascular resistance in AVF-associated HOHF leads to activation of the sympathetic nervous system and renin angiotensin aldosterone system, further inducing pathologic cardiac remodeling.…”

Arteriovenous Vascular Access Selection and Evaluation

“…A prospective magnetic resonance (MR) study among CKD stage 5 patients demonstrated significant increases in LA size, LVEDV, LV mass, and cardiac output at 6 months after fistula creation. 55 However, interpretation of these findings must be tempered by the lack of a control group, which makes it difficult to separate the effect of a progressive decline in kidney function (and subsequent volume overload) from the effect of fistula creation.…”

“…Similar to the increase in LV workload, there is an increase in RV systolic performance as well as increased right atrial size and RVEDV. 55 The increase in blood volume as well as the increased RV performance may lead to increased pulmonary flow and possibly increased pulmonary pressure resulting in pulmonary hypertension. There may be a relationship between the degree of pulmonary hypertension and the age and flow rate of the fistula.…”