Abstract
Introduction: Pulmonary Hypertension (PH) is a common sequelae of arteriovenous fistulas (AVF) and grafts (AVG) due to the creation of shunt physiology and increased pulmonary blood flow. PH has been consistently associated with increased mortality but there is a paucity of data in regards to management. Methods: Using the United States Renal Data System, we identified all patients over age 18 initiated on dialysis from 2012-2019 who did not receive renal transplant. We identified a) predictors for the development of PH; b) analyzed survival for patients with PH who had their AVF or AVG removed. Results: We identified 478,896 patients initiated on dialysis from 2012-2019 of whom 27,787 (5.8%) had PH. The median age was 65 (IQR: 55-74) years and 59.1% were male. Reduced ejection fraction, any congestive heart failure, obstructive sleep apnea, and female sex were the strongest predictors of PH. AVG and AVF were also associated with an increased rate of PH relative to catheter-based dialysis (p<0.001). Among patients with PH, the removal of AVF or AVG was associated with significantly improved survival (p<0.001). Conclusions: Patients with AVA should be screened using echocardiography and those with PH should be strongly considered for AVA removal or revision.
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