Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease.
OBJECTIVE
Short-term studies have reported left ventricular (LV) dilatation following surgical creation of arteriovenous fistulas (AVF) or arteriovenous grafts (AVGs), but chronic cardiac structural and functional changes have not been examined or related to clinical outcomes following AVF/AVG. We sought to characterize the long-term changes in cardiac structure and function in patients undergoing shunt creation for haemodialysis.


RESULTS
A retrospective analysis was performed of patients undergoing echocardiography before and after surgical AVF/AVG creation for the initiation of haemodialysis. 137 patients underwent echocardiographic examinations prior to AVF and 2.6 years (median) after AVF creation. Following AVF and dialysis initiation, there were reductions in blood pressure, body weight and estimated plasma volume coupled with modest reverse LV remodelling. In contrast, AVF/AVG creation was associated with significant right ventricular (RV) dilatation and deterioration in RV function. Incident heart failure (HF) developed in 43% of patients in tandem with greater RV remodeling. The development of RV dilation following surgical AVF/AVG was independently associated with increased risk of death [HR 3.9, 95% CI (1.7-9.2), P = 0.001].


CONCLUSIONS
In long-term follow-up, RV remodelling and dysfunction develop following AVF/AVG creation and dialysis initiation, despite improved control of LV pressure load through dialysis. Deleterious effects on right heart structure and function are coupled with development of incident HF and increased risk of death. Further study is required to identify patients at greatest risk for detrimental AVF/AVG changes who may benefit from alternate forms of dialysis or potentially ligation of existing AVF.
Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905, USA.
Yogesh N V
YNV
Reddy
Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905, USA.
Masaru
M
Obokata
Division of Transplantation Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905, USA.
Patrick G
PG
Dean
Department of Cardiology, IKEM, Videnska 1958/9, Prague 4, 140 28, Czech Republic.
Vojtech
V
Melenovsky
Division of Nephrology and Hypertension, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905, USA.
Karl A
KA
Nath
Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905, USA.
Barry A
BA
Borlaug
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001794:Blood Pressure / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D059347:Cardio-Renal Syndrome / Q000209:etiology / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D010953:Plasma Volume / Q000502:physiology; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology
Arteriovenous fistula; Dialysis; Heart failure; Kidney