Arteriovenous fistula and heart failure: cardiac echoes of hemodynamic stress
G Ramonaite, V Samsone, L Rimsevicius, B Vaisnyte, E Zurauskas, M MiglinasAbstract
Introduction
Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis in patients with end-stage renal disease (ESRD) due to its superior long-term patency and lower risk of infection. However, the creation of an AVF results in a persistent increase in blood flow and altered systemic hemodynamics, which could promote the development or progression of heart failure (HF). Additionally, hemodynamic disturbance is a cause of vacular remodeling. Given the high burden of HF in ESRD, understanding the relationship between AVF-related vascular changes and cardiac structure and function is clinically relevant.
Purpose
To investigate the association between cardiac function and AVF histological characteristics in patients with ESRD, and to assess the prevalence of common cardiovascular risk factors.
Methods
This retrospective study included ESRD patients with a functioning AVF. Cardiovascular risk factors (dyslipidemia, diabetes mellitus, body mass index [BMI]), cardiac status (presence and type of HF, left ventricular end-diastolic and end-systolic diameters [LVEDD/LVESD]), and AVF histological findings (fibrosis) were analyzed. Statistical analyses were performed using R software. Continuous variables were expressed as mean ± standard deviation or median with interquartile range, and categorical variables were compared using chi-square or Fisher’s exact test. A p-value <0.05 was considered statistically significant.
Results
A total of 56 patients were included (mean age 56.4 ± 15 years; 42.9% female). HF was present in 75% of patients, with 42.9% classified as congestive and 57.1% as non-congestive HF. Mean LVEDD was 5.2 ± 0.7 cm and median LVESD was 3.5 cm [IQR 2.4–3.8]. Dyslipidemia was present in 48.2% of patients, diabetes mellitus in 17.9%, and above-normal BMI in 61.4% (median BMI 26.3 [IQR 23.1–30]). AVF fibrosis was identified in 48.2% of cases and was similarly prevalent across HF subtypes. Significant associations were observed between BMI and diabetes (p=0.004), diabetes and HF type (p=0.01), and dyslipidemia and HF type (p=0.001). Marginal associations were noted between intimal AVF fibrosis and LVEDD (p=0.06) and LVESD (p=0.054).
Conclusions
Heart failure was highly prevalent among ESRD patients in this cohort. While no statistically significant association between AVF fibrosis and cardiac structural parameters was identified, marginal findings suggest a potential relationship that may become evident in larger studies or with more detailed histological assessment and advanced imaging techniques. The high prevalence of cardiovascular risk factors underscores the importance of their timely management to improve cardiac outcomes in ESRD patients.