Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease

Yogesh N.V. Reddy, Masaru Obokata, Patrick G. Dean, Vojtech Melenovsky, Karl A Nath, Barry A Borlaug

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Aims 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. Methods and 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]. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)1913-1923
Number of pages11
JournalEuropean Heart Journal
Volume38
Issue number24
DOIs
StatePublished - Jun 21 2017

Fingerprint

Arteriovenous Fistula
Chronic Kidney Failure
Transplants
Ventricular Remodeling
Dialysis
Dilatation
Renal Dialysis
Heart Failure
Right Ventricular Dysfunction
Right Ventricular Function
Plasma Volume
Ventricular Pressure
Ligation
Echocardiography
Body Weight
Blood Pressure

Keywords

  • Arteriovenous fistula
  • Dialysis
  • Heart failure
  • Kidney

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease. / Reddy, Yogesh N.V.; Obokata, Masaru; Dean, Patrick G.; Melenovsky, Vojtech; Nath, Karl A; Borlaug, Barry A.

In: European Heart Journal, Vol. 38, No. 24, 21.06.2017, p. 1913-1923.

Research output: Contribution to journalArticle

Reddy, Yogesh N.V. ; Obokata, Masaru ; Dean, Patrick G. ; Melenovsky, Vojtech ; Nath, Karl A ; Borlaug, Barry A. / Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease. In: European Heart Journal. 2017 ; Vol. 38, No. 24. pp. 1913-1923.
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abstract = "Aims 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. Methods and 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]. Conclusion 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.",
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N2 - Aims 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. Methods and 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]. Conclusion 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.

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