Journal Article

Effects of arteriovenous fistula formation on arterial stiffness and cardiovascular performance and function

Shvan Korsheed, Mohamed. T. Eldehni, Stephen G. John, Richard J. Fluck and Christopher W. McIntyre

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 10, pages 3296-3302
Published in print October 2011 | ISSN: 0931-0509
Published online February 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq851
Effects of arteriovenous fistula formation on arterial stiffness and cardiovascular performance and function

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Background. Native arteriovenous fistula (AVF) is the vascular access of choice and its use cf. catheters is associated with sustained reduction in mortality. This may be due to factors beyond dialysis catheter-associated sepsis. This study aimed to investigate the impact of AVF formation on the spectrum of cardiovascular factors that might be important in the pathophysiology of cardiovascular diseases in chronic kidney disease (CKD) patients.

Methods. We recruited 43 pre-dialysis patients who underwent AVF formation. Patients were studied 2 weeks prior to AVF operation and 2 weeks and 3 months post-operatively. Haemodynamic variables were measured using pulse wave analysis, carotid femoral pulse wave velocity (CF-PWV) by applanation tonometry and AVF blood flow by Doppler ultrasound. Bioimpedence analysis was performed and patients underwent serial transthoracic echocardiography.

Results. AVF formation was successful in 30/43 patients. Two weeks post-operatively, total peripheral resistance decreased (−17 ± 18%, P = 0.001), stroke volume tended to rise (12 ± 30 mL, P = 0.053) and both heart rate (4 ± 8 bpm, P = 0.01) and cardiac output (1.1 ± 1.5 L/min, P = 0.001) increased. Systolic and diastolic blood pressures (BPs) reduced (−9 ± 18 mmHg; −9 ± 10 mmHg; ≤P = 0.006) and CF-PWV reduced (−1.1 ± 1.5 m/s, P = 0.004). Left ventricular ejection fraction (LVEF) increased (6 ± 8%, P < 0.001). All the observed changes were largely maintained after 3 months. No change in hydration status/body composition was observed.

Conclusions. AVF formation resulted in a sustained reduction in arterial stiffness and BP as well as an increase in LVEF. Overall, post-AVF adaptations might be characterized as potentially beneficial in these patients and supports the widespread use of native vascular access, including older or cardiovascular compromised individuals.

Keywords: arterial stiffness; arteriovenous fistula; cardiac output; pulse wave velocity; vascular access

Journal Article.  4651 words.  Illustrated.

Subjects: Nephrology

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