Impact of Arteriovenous Access Formation on Cardiac Structure and Function in Hemodialysis Patients.

Abstract

Objectives: We aimed to determine echocardiographic changes following arteriovenous fistula (AVF) creation and identify predictors of major adverse cardiac events (MACE) in end-stage renal disease (ESRD) patients.

Methods: A retrospective study of ESRD patients who underwent AVF creation between 2014 and 2022 was conducted at a tertiary care center. Cardiac echocardiograms performed within 3 months before and at least 6 months after surgery were compared using paired t-tests. Predictors of MACE were assessed using Cox regression, with results reported as hazard ratios (HR).

Results: A total of 119 patient records were included. Mean age was 58.2 ± 13.6 years, and 66 (55.5%) patients were male. Following the procedure, left atrial volume index (LAVI) increased (34.339 ± 10.361 vs. 37.964 ± 9.739, p = 0.001), whereas E' velocity (0.052 ± 0.018 vs. 0.047 ± 0.016, p = 0.011) and left-ventricular ejection fraction (50.798 ± 11.442 vs. 47.374 ± 12.277, p <0.001) decreased significantly. Ejection fraction was maintained in 81 patients (68.07%), improved in 12 (10.08%), and declined in 26 (21.85%). Cox regression showed a significant association between preoperative atrial fibrillation (p = 0.019) and severe left ventricular dysfunction (p = 0.026) with MACE.

Conclusion: AVF creation was associated with increased LAVI and decreased E' velocity. Preoperative atrial fibrillation and severe left ventricular dysfunction were associated with increased risk of postoperative MACE.