Effect of Radiocephalic and Brachiocephalic Arteriovenous Fistula on Cardiac Function in Hemodialysis Patient.

Objectives: End-stage renal disease (ESRD) is very common and affecting almost 10% of the population worldwide. Arterio-venous fistulas (AVFs) become first access options for hemodialysis but AVFs may contribute to maladaptive cardiovascular remodelling. Methods: We studied the efect of radiocephalic AVFs (RC-AVFs) and brachiocephalic AVFs (BC-AVFs) creation on cardiac structure and function in patients with ESRD. In this study patients with listed for AVF creation underwent echocardiography before and six weeks after the surgery. The primary outcome was changes in left ventricle (LV) volumes and LV ejection fraction. The secondary outcome was determinining which type of fistula increases the likelihood of cardiovascular remodelling more. Results: Between November 2022 and March 2023, a total of 38 patients (mean age 62 years) who underwent AVFs surgery were included in the study. Out of these patients, 17 received RC-AVFs, while 21 patients received BC-AVFs. Echocardiography revealed a significant increase in left ventricular end-diastolic pressure (LVEDP) in both groups (p=0.02). The increase in LVEDP was found to be significantly higher in the BC-AVFs group compared to the RC-AVFs group (p=0.03). However, there were no significant changes observed in ejection fraction. Conclusions: AVF creation is a critical treatment method in ESRD. However, high-flow fistulas carry a substantial risk potential in patients with underlying cardiovascular diseases. To avoid an increase in left ventricular pressure (LVP), especially in BC-AVFs, it is possible to create smaller diameter artery and vein anastomoses. This approach can help minimize the risk of elevated LVP associated with AVFs. [ABSTRACT FROM AUTHOR]