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Effect of high flow arteriovenous fistula on cardiac function in hemodialysis patients
Mohamed Ayman Saleh1, Wael Mahmoud El Kilany1, Viola William Keddis1
1Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Insights
High flow access (HFA) in hemodialysis patients is common and linked to heart problems. HFA is associated with enlarged heart chambers and reduced heart function, increasing the risk of high output heart failure.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- High flow access (HFA) in hemodialysis (HD) may lead to high output heart failure (HOHF).
- Understanding the prevalence and cardiac effects of HFA is crucial for HD patient management.
Purpose of the Study:
- To determine the prevalence of HFA in chronic HD patients.
- To investigate the impact of HFA on cardiac dimensions and function.
Main Methods:
- A cross-sectional study of 100 chronic HD patients with arteriovenous fistula (AVF).
- Patients were divided into non-HFA (Qa < 2000 ml/min) and HFA (Qa ≥ 2000 ml/min) groups.
- AVF flow (Qa) measured by Doppler ultrasonography; cardiac function assessed by echocardiography.
Main Results:
- HFA prevalence was 24% among the study population.
- HFA group showed significant left ventricular (LV) dilatation and increased left atrial (LA) volume.
- LV ejection fraction (EF) was significantly lower in the HFA group (57.32% vs. 62.90%).
- A high Qa/cardiac output (CO) ratio (≥20%) was significantly associated with HFA.
Conclusions:
- HFA is a prevalent issue in hemodialysis vascular access.
- HFA is linked to dilated LV dimensions and impaired LV systolic function.
- A high Qa/CO ratio independently predicts HOHF in HD patients.
Background:
Vascular access for hemodialysis (HD) with an inappropriately high flow may underlie the onset of high output heart failure (HOHF).The aim of this study was to determine the prevalence of high flow access (HFA) in chronic HD patients, and to determine its effects on cardiac functions.
Methods:
This cross sectional study was conducted on 100 chronic hemodialysis patients through arteriovenous fistula (AVF). The study cohort was subdivided into 2 groups based on AVF flow: Group A (Non-HFA group with Qa < 2000 ml/min), and Group B (HFA group with Qa ≥ 2000 ml/min). AVF flow (Qa) was assessed using Color Doppler ultrasonography. Transthoracic echocardiography was performed for all patients to assess cardiac dimensions and functions.
Results:
Prevalence of HFA among study population was 24%. Mean AVF Qa was 958.63 ± 487.35 and 3430.13 ± 1256.28 ml/min, for group A and B respectively. The HFA group demonstrated a significant dilatation in LV dimensions and volumes and significantly larger LA volume as compared to non-HFA group. A significantly lower LV ejection fraction [EF] was also observed in group B with a mean value of 57.32 ± 6.19% versus 62.90 ± 5.76%. A significant association between HFA group and high Qa/cardiac output (CO) ratio (≥20%) was also observed.
Conclusion:
HFA is a prevalent hemodialysis vascular access problem. HFA was associated with dilated LV dimensions, impaired LV systolic function. High Qa/CO ratio (≥20%) was an independent predictor of high output heart failure (HOHF) in our study population.
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