The cardiovascular and functional consequences of arteriovenous fistula formation in chronic kidney disease

Korsheed, Shvan (2011) The cardiovascular and functional consequences of arteriovenous fistula formation in chronic kidney disease. DM thesis, University of Nottingham.

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Background. Native arteriovenous fistula (AVF) is the vascular access of choice and its use c.f. catheters is associated with sustained reduction in mortality. This may be due to factors beyond dialysis catheter associated sepsis. This study aims to investigate the impact of AVF formation on the spectrum of cardiovascular factors that might be important in the pathophysiology of cardiovascular diseases in CKD patients.

Methods. We recruited 43 pre-dialysis patients who underwent AVF formation. Patients were studied two weeks prior to AVF operation, two weeks and three months postoperatively. Haemodynamic variables were measured using pulse wave analysis, carotid femoral pulse wave velocity (CF-PWV) by applanation tonometry and AVF blood flow by Doppler ultrasound. Bioimpedence analysis was performed and patients underwent serial transthoracic echocardiography. Laser Doppler Perfusion Imaging and iontophoresis were used to assess endothelial dependant (ED) and non-endothelial dependant (NED) vasodilatation.

Results. AVF formation was successful in 30/43 patients. Two weeks postoperatively, total peripheral resistance decreased (-17 18%, p=0.001), stroke volume tended to rise (12 30ml, p=0.053) and both heart rate (4 8bpm, p=0.01) and cardiac output (1.1 1.5l/min, p=0.001) increased. Systolic and diastolic blood pressures reduced (-9 18mmHg; -9 10mmHg; ≤ p=0.006). CF-PWV reduced (-1.1 1.5m/sec, p=0.004). Left ventricular ejection fraction (LVEF) increased (6 8%, p<0.001). Patients with successful AVF formation had a significantly reduced ED vasodilatation in the fistula arm -36±46%, p<0.001. Only NED vasodilatation was significantly reduced in the non-fistula arm 23±40%, p=0.01. Patients who had unsuccessful AVF operation exhibited no recordable changes.

All the observed haemodynamic changes were largely maintained after 3 months. No change in hydration status/body composition was observed. AVF formation resulted in a sustained reduction in arterial stiffness and BP as well as an increase in LVEF. Furthermore, there were significant changes in the local and systemic microcirculation. Overall, post AVF adaptations might be characterised as potentially beneficial in these patients and supports the widespread use of native vascular access, including older or cardiovascular compromised individuals.

Item Type: Thesis (University of Nottingham only) (DM)
Supervisors: McIntyre, C.
Keywords: Endothelial dysfunction, Arteriovenous fistula, Vascular access, Arterial stiffness, Cardiovascular physiology
Subjects: W Medicine and related subjects (NLM Classification) > WJ Urogenital system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Graduate Entry Medicine and Health
Item ID: 12032
Depositing User: EP, Services
Date Deposited: 09 Aug 2013 06:39
Last Modified: 14 Sep 2016 11:41

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