Echocardiographic changes after arteriovenous fistula creation in hemodialysis patients.

Abstract

Pulmonary hypertension (PH) is common in end-stage renal disease (ESRD) patients and is associated with increased all-cause and cardiovascular mortality in this group. There is scarce data on the long-term effect of arteriovenous fistula (AVF) creation on pulmonary hypertension (PH) and the reflected changes in echocardiographic measurements. This is a retrospective study of 54 patients who underwent AVF creation between 2009 and 2014 and with echocardiographic evaluations before and after surgery. We analyzed pairwise changes in right ventricular systolic pressure (RVSP), right atrial pressure (RAP) during systole, left ventricular mass (LVM), tricuspid regurgitation (TR), mitral E/E' ratio, and ejection fraction (EF), as well as the factors that predicted change in RVSP after surgery. The median time for the preoperative echocardiogram was 0.3 years (interquartile range (IQR) 0.2-0.7 years) prior to AVF creation, while the follow-up echo was done 1.3 (0.6-2.1) years after surgery. 67% of the patients had RVSP>37 mmHg at baseline. There was a significant reduction in RVSP after AVF creation compared to baseline (median 33 (IQR 26-43) vs. 46mmHg, p=0.0015), with 59% of the patients experiencing a decrease and 19% remaining stable. There were also significant decreases in LVM (201 (143-256) vs. 215 (163-276), p=0.045) and RAP systole (10 (10-15) vs. 3 (3-8); p<0.001) after surgery. Higher preoperative weight (p=0.038) and RVSP (p=0.006), and use of loop diuretics (p=0.015) were significantly associated with improvement in RVSP after AVF creation. Our results suggest that AVF creation is associated with a significant reduction or stable measurements of RVSP in the ESRD population, likely due to an improvement in volume status.