Correlation Between Arteriovenous Fistula Flow Patterns and Impaired Cardiac Systolic Function in Hemodialysis Patients with End Stage Kidney Disease.

Author(s): Riyadh M Al-Saegh

Abstract Background Cardiovascular disease stands as the leading cause of mortality and morbidity among patients with chronic kidney disease. Notably, arteriovenous fistulas show the highest long-term patency rate when compared to alternative hemodialysis access methods. However, the creation of these fistulas raises concerns about potential adverse effects on cardiac structure and function. These physiological consequences could escalate to the point of myocardial decompensation, leading to decreased ejection fraction and potentially resulting in left ventricular hypertrophy and/or heart failure. Method Conducted at Imam Al-Hussein Medical City and Imam Al-Hassan Hospital in the city of Karbala, this cross-sectional study spanned from January to June 2022. The study enrolled a cohort of one hundred fifty patients diagnosed with end stage kidney disease on regular hemodialysis schedules. Each participant underwent color Doppler ultrasonography to assess fistula characteristics, alongside transthoracic echocardiography for a comprehensive evaluation of cardiac function. Results The study findings revealed that the prevalence of high flow fistulas among the participants was 41.3% (62 patients), while 50% exhibited normal flow (75 patients), and 8.7% (13 patients) demonstrated low flow characteristics. Conclusion Notably, a statistically significant association emerged between the type of flow observed in arteriovenous fistulas and the systolic function of the heart (P-value = 0.032). Patients with high flow velocity fistulas displayed a notably higher prevalence of reduced systolic function. Moreover, patients with fistulas situated in the arm exhibited greater flow velocities when compared to those with forearm fistulas.