Impact of Arteriovenous Access Formation on Cardiac Structure and Function in Hemodialysis Patients

We aimed to determine echocardiographic changes following arteriovenous fistula (AVF) creation and identify predictors of major adverse cardiac events (MACE) in end-stage renal disease (ESRD) patients.

A retrospective study of ESRD patients who underwent AVF creation between 2014 and 2022 was conducted at a tertiary care center. Cardiac echocardiograms performed within 3 months before and at least 6 months after surgery were compared using paired t-tests. Predictors of MACE were assessed using Cox regression, with results reported as hazard ratios (HR).

A total of 119 patient records were included. Mean age was 58.2 ± 13.6 years, and 66 (55.5%) patients were male. Following the procedure, left atrial volume index (LAVI) increased (34.339 ± 10.361 vs. 37.964 ± 9.739, p = 0.001), whereas E' velocity (0.052 ± 0.018 vs. 0.047 ± 0.016, p = 0.011) and left-ventricular ejection fraction (50.798 ± 11.442 vs. 47.374 ± 12.277, p <0.001) decreased significantly. Ejection fraction was maintained in 81 patients (68.07%), improved in 12 (10.08%), and declined in 26 (21.85%). Cox regression showed a significant association between preoperative atrial fibrillation (p = 0.019) and severe left ventricular dysfunction (p = 0.026) with MACE.

AVF creation was associated with increased LAVI and decreased E' velocity. Preoperative atrial fibrillation and severe left ventricular dysfunction were associated with increased risk of postoperative MACE.