title: Effects of arteriovenous fistula formation on arterial stiffness and cardiovascular performance and function.
abstract: BACKGROUND
  Native arteriovenous fistula (AVF) is the vascular access of choice and its use cf. catheters is associated with sustained reduction in mortality. This may be due to factors beyond dialysis catheter-associated sepsis. This study aimed to investigate the impact of AVF formation on the spectrum of cardiovascular factors that might be important in the pathophysiology of cardiovascular diseases in chronic kidney disease (CKD) patients.
  
  
  METHODS
  We recruited 43 pre-dialysis patients who underwent AVF formation. Patients were studied 2 weeks prior to AVF operation and 2 weeks and 3 months post-operatively. Haemodynamic variables were measured using pulse wave analysis, carotid femoral pulse wave velocity (CF-PWV) by applanation tonometry and AVF blood flow by Doppler ultrasound. Bioimpedence analysis was performed and patients underwent serial transthoracic echocardiography.
  
  
  RESULTS
  AVF formation was successful in 30/43 patients. Two weeks post-operatively, total peripheral resistance decreased (-17 ± 18%, P = 0.001), stroke volume tended to rise (12 ± 30 mL, P = 0.053) and both heart rate (4 ± 8 bpm, P = 0.01) and cardiac output (1.1 ± 1.5 L/min, P = 0.001) increased. Systolic and diastolic blood pressures (BPs) reduced (-9 ± 18 mmHg; -9 ± 10 mmHg; ≤ P = 0.006) and CF-PWV reduced (-1.1 ± 1.5 m/s, P = 0.004). Left ventricular ejection fraction (LVEF) increased (6 ± 8%, P < 0.001). All the observed changes were largely maintained after 3 months. No change in hydration status/body composition was observed.
  
  
  CONCLUSIONS
  AVF formation resulted in a sustained reduction in arterial stiffness and BP as well as an increase in LVEF. Overall, post-AVF adaptations might be characterized as potentially beneficial in these patients and supports the widespread use of native vascular access, including older or cardiovascular compromised individuals.
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Derby, UK. s.korsheed@googlemail.com
authors.forename: Shvan
authors.initials: S
authors.lastname: Korsheed
authors.forename: Mohamed T
authors.initials: MT
authors.lastname: Eldehni
authors.forename: Stephen G
authors.initials: SG
authors.lastname: John
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Fluck
authors.forename: Christopher W
authors.initials: CW
authors.lastname: McIntyre
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula; D001166:Arteriovenous Shunt, Surgical; D001794:Blood Pressure; D002302:Cardiac Output; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D013318:Stroke Volume; D059289:Vascular Stiffness / Q000502:physiology*