Arteriovenous Fistulas May Increase Heart Failure Risk

Jody A. Charnow March 21, 2012

re!e"#tive #lace"ent o$ an arteriovenous $istula %A&F' in #re!dialysis #atients with advanced chronic kidney disease %C()' "ay increase their risk o$ con*estive heart $ailure %CHF', a study $ound. Researchers studied +,2 #atients with sta*e -!+ #re!dialysis C(). .ative A&Fs were created in 1,0 #atients who chose he"odialysis as the initial "odality $or renal re#lace"ent thera#y. Acute deco"#ensated CHF develo#ed in /+ #atients %101'. 2he incidence rate was 1/ e#isodes #er 1,000 #atient!years. Creation o$ a success$ul A&F was associated with a si*ni$icant /.+ ti"es increased risk o$ CHF, accordin* to a re#ort #u3lished online ahead o$ #rint in Nefrologia. 2he risk o$ develo#in* CHF durin* the #eriod $ollowin* A&F creation was si*ni$icantly *reater in #atients with a #ro4i"al A&F than in those with a distal A&F, Roc5o Mart5ne6!7allardo, M), and collea*ues at Hos#ital In$anta Cristina in 8ada9o6, :#ain, $ound. 2he "edian ti"e 3etween A&F creation and a CHF e#isode was +1 days. Accordin* to the researchers, the short ti"e s#an 3etween A&F creation and CHF develo#"ent, alon* with the hi*her $re;uency o$ CHF in #atients with a #ro4i"al A&F, su##ort a connection 3etween the two. 2he "ortality o$ #atients with CHF was si"ilar to that o$ the other study su39ects, althou*h un#lanned dialysis initiation occurred si*ni$icantly "ore $re;uently in #atients who e4#erienced CHF, )r. Mart5ne6! 7allardo<s tea" stated. 2he association 3etween A&F and CHF in dialysis #atients #reviously had 3een considered incidental, the authors o3served. 2hey e4#lained, however, that creation o$ an A&F causes he"odyna"ic chan*es that can $avor develo#"ent o$ CHF. 2hese chan*es include increased cardiac venous return, increased heart rate and contractility, and increased $illin* #ressures, which lead to a *reater cardiac out#ut, increased #las"a volu"e, and decreased #eri#heral resistance, they noted. 2he researchers said the results o$ their study su##ort a reco""endation that vascular sur*eons try to create distal A&Fs in #re!dialysis #atients, #articularly in those with risk $actors $or develo#in* CHF. In addition, the authors reco""end strict $ollow!u# o$ cardiovascular tolerance and res#onse to the creation o$ A&F, which would allow $or an early dia*nosis o$ CHF. 8I8=I>7RA H?@ htt#@AAwww.renalandurolo*ynews.co"Aarteriovenous!$istulas!"ay!increase!heart!$ailure! riskAarticleA2BB00CAD