Abstract 14462: Elective Arterio-Venous Fistula Creation in Chronic Kidney Disease is Associated With Maladaptive Cardiovascular Adaptation: A Cardiovascular MRI Study
Introduction: Chronic kidney disease (CKD) is associated with a marked increase in cardiovascular risk. We sought to evaluate the independent impact of arterio-venous fistula creation on cardiovascular structure and function prior to dialysis commencement utilising cardiovascular MRI (CMR).
Methods: Utilising CMR, we assessed cardiac and vascular structure and function immediately prior to, and 6-months following, elective AVF creation in preparation for subsequent haemodialysis commencement.
Results were compared against a matched control group of CKD patients not undergoing elective AVF creation. Results: Twenty-four CKD patients were assessed (age 59±12 years, 58% male, eGFR=9.1±0.6mL/min/1.73m2). AVF creation was associated with a 25.0% increase in mean cardiac output (7.5±1.5L/min vs. 9.4±2.2L/min, p<0.0001) and associated increases in bi-ventricular chamber dimensions (LVEDV 149±31mL vs. 175±43mL, p<0.0001; RVEDV 142±32mL vs. 167±42mL p<0.0001), left ventricular mass (132±32g vs. 149±35g, p<0.0001) and bi-atrial dilatation (Left atrial area 27±6cm2vs. 30±6cm2, p=0.0003; Right atrial area 23±6cm2 vs. 25±6cm2, p=0.0046). Furthermore, AVF creation was associated with deterioration in brachial artery flow-mediated dilatation (9.0±9.2% vs. 3.0±5.7%, p=0.012), but there was no detectable effect on central vascular compliance as assessed by aortic distensibility (2.3±1.2mmHg-1 vs. 2.2±1.2mmHg-1, p=0.59).
Conclusion: Independent of the effects of dialysis, the surgical creation of an AVF significantly increases ventricular work with an associated increase in atrial and ventricular chamber volumes. Furthermore, AVF creation is associated with an increase in left ventricular mass and deterioration in peripheral endothelial function - parameters closely linked with increased risk for cardiovascular events. In the context of advanced renal dysfunction, the potential for AVF creation to promote adverse cardiovascular remodelling requires consideration.
- © 2011 by American Heart Association, Inc.