#1276 Arteriovenous fistula flow: unlocking the link to cardiac complications in hemodialysis patients

Abstract

Abstract Background and Aims The impact of arteriovenous fistulas (AVFs) on cardiac health in long-term hemodialysis patients, particularly their role in heart failure (HF), remains controversial. This study examines the relationship between AVF flow and cardiac function to determine HF prevalence. It identifies an AVF flow threshold predictive of HF risk and evaluates cardiac changes over six months in patients with end-stage kidney disease. Method This study prospectively tracked 92 individuals undergoing dialysis from their initial enrollment to subsequent follow-ups at three and six months. Evaluations encompassed clinical assessments, heart imaging via echocardiography, Doppler ultrasound to measure AVF blood flow, and laboratory tests. The severity of heart failure (HF) was classified using the New York Heart Association (NYHA) system. Results The average duration of dialysis prior to inclusion was 31.75 ± 16.62 months. Approximately 38% of participants were diagnosed with HF. Patients with HF displayed significantly higher AVF flow rates compared to those without HF (P < 0.001). Receiver operating characteristic (ROC) analysis identified an AVF flow threshold of ≥1230 mL/min as a robust indicator of HF risk (AUC: 0.988, CI 95%: 0.93–1.00, P < 0.0001). Over the monitoring period, left ventricular ejection fraction (EF) and shortening fraction (SF) showed slight increases without statistical significance, likely due to a significant rise in hemoglobin levels (P = 0.009) and reductions in blood pressure (P = 0.482 for systolic and P = 0.025 for diastolic). Although cardiac output and AVF flow decreased, no significant relationship was observed between the two. Additionally, the left ventricular mass index (LVMi), an indicator of heart strain, was notably higher in participants with HF compared to those without (P < 0.001). Conclusion Effectively managing high blood pressure, anemia, and ventricular hypertrophy is crucial to slowing HF progression in individuals with end-stage kidney disease. An AVF flow rate of ≥1230 mL/min serves as a strong predictor for identifying patients at greater risk of developing HF.