[Arterio-venous fistula and cardiovascular system disturbances]

There is an increasing number of patients with end-stage renal disease all over the world, mainly in the population of patients with diabetic nephropathy and in the elderly. One of the most important issues in nephrology care is the vascular access. The closest to the ideal vascular access is the native arterio-venous fistula. On the other hand, patients with end-stage renal failure are prone to cardiovascular complications, including left ventricular hypertrophy, cardiomyopathy, accelerated arterio- and atherosclerosis, vascular remodeling. Congestive heart failure is 20-fold more common than in the general population, and is found in about 30% of dialyzed patients, whereas left ventricular hypertrophy in 75%. Creating vascular access in patients with already established cardiovascular complications, may enhance the risk of exacerbation of cardiovascular complications with a negative effect on the patients' survival. The novel cardiovascular problems following vascular access creation may include: decompensation of congestive heart failure, pulmonary hypertension, inadequately low blood flow in the fistula with subsequent inadequate dialysis and fistula thrombosis, fistula infection (with local and systemic symptoms), and micro-inflammation (particularly in the politetrafluoroethylene grafts). The data concerning mutual relationship between vascular access and cardiovascular system in hemodialyzed patients are very scarce, mainly casual. In the review the updated status concerning the effects of vascular access creation on the cardiovascular system is presented.