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

Benjamin K Dundon, Kim Torpey, Adam J. Nelson, Dennis TL Wong, Rae F. Duncan, Ian T Meredith, Randall J. Faull, Stephen G Worthley, Matthew I. Worthley

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23 Citations (Scopus)

Abstract

Aim: Arteriovenous fistula-formation remains critical for the provision of hemodialysis in end-stage 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.

Results: At follow up, left ventricular ejection fraction remained unchanged, while mean cardiac output increased by 25.0% (P<0.0001). Significant increases in left and right ventricular end-systolic volumes (21% [P=0.014] and 18% [P<0.01]), left and right atrial area (11% [P<0.01] and 9% [P<0.01]), 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.

Original languageEnglish
Pages (from-to)337-345
Number of pages9
JournalInternational Journal of Nephrology and Renovascular Disease
Volume7
DOIs
Publication statusPublished - 16 Sep 2014
Externally publishedYes

Keywords

  • Cardiac
  • Cardiovascular disease
  • Vascular biology

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