Interrogating the haemodynamic effects of haemodialysis arteriovenous fistula on cardiac structure and function

Stoumpos, S. et al. (2021) Interrogating the haemodynamic effects of haemodialysis arteriovenous fistula on cardiac structure and function. Scientific Reports, 11, 18102. (doi: 10.1038/s41598-021-97625-5) (PMID:34518583) (PMCID:PMC8437985)

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Arteriovenous fistula (AVF) is the preferred type of vascular access for maintenance haemodialysis but it may contribute to maladaptive cardiovascular remodelling. We studied the effect of AVF creation on cardiac structure and function in patients with chronic kidney disease (CKD). In this prospective cohort study patients with CKD listed for first AVF creation underwent cardiac magnetic resonance (CMR) imaging at baseline and at 6 weeks. All participants had ultrasound measurements of fistula blood flow at 6 weeks. The primary outcome was the change in left ventricular (LV) mass. Secondary outcomes included changes in LV volumes, LV ejection fraction, cardiac output, LV global longitudinal strain and N-terminal-pro B-type natriuretic peptide (NT-proBNP). A total of 55 participants were enrolled, of whom 40 (mean age 59 years) had AVF creation and completed both scans. On the second CMR scan, a mean increase of 7.4 g (95% CI 1.1–13.7, p = 0.02) was observed in LV mass. Significant increases in LV end-diastolic volumes (p = 0.04) and cardiac output (p = 0.02) were also seen after AVF creation. No significant changes were observed in LV end-systolic volumes, LV ejection fraction, NT-proBNP and LV global longitudinal strain. In participants with fistula blood flows ≥ 600 mL/min (n = 22) the mean increase in LV mass was 15.5 g (95% CI 7.3–23.8) compared with a small decrease of 2.5 g (95% CI − 10.6 to 5.6) in participants with blood flows < 600 mL/min (n = 18). Creation of AVF for haemodialysis resulted in a significant increase of LV myocardial mass within weeks after surgery, which was proportional to the fistula flow.

Item Type:Articles
Additional Information:The study was funded by the endowment fund of the Glasgow Renal and Transplant Unit.
Glasgow Author(s) Enlighten ID:McGregor, Dr Ellon and Thomson, Dr Peter and Roditi, Dr Giles and Welsh, Professor Paul and Kingsmore, Prof David and Mangion, Dr Kenneth and Kasthuri, Dr Ram and Mark, Professor Patrick and Stoumpos, Dr Sokratis and Rankin, Dr Alastair and Stevenson, Dr Karen and Hall Barrientos, Dr Pauline
Authors: Stoumpos, S., Rankin, A., Hall Barrientos, P., Mangion, K., McGregor, E., Thomson, P. C., Stevenson, K., Welsh, P., Kasthuri, R., Kingsmore, D., Roditi, G., and Mark, P. B.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Scientific Reports
Publisher:Nature Research
ISSN (Online):2045-2322
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Scientific Reports 11:18102
Publisher Policy:Reproduced under a Creative Commons License

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