Arteriovenous Fistula Has Better Cardiac Outcome Than Permanent Catheter in Hemodialysis Patients with Heart Failure

Abstract

Abstract Background and Aims End stage renal disease patients with heart failure (HF) are at high-risk to develop clinical worsening after arteriovenous fistula (AVF) construction. This study evaluates effects of AVF versus permanent catheter on cardiac parameters in prevalent hemodialysis patients with heart failure and its relation to short term dialysis outcome. Methods A prospective study included 60 hemodialysis patients with HF ejection fraction (EF) 35- 50%. Patients were divided into: 30 patients with distal AVF, 30 patients with permanent hemodialysis catheter. Echocardiography was done for all patients at the beginning of the study and after 6 months with follow up of short term dialysis outcome. Result Patients with AVF after 6 months had significant improvement in TSAT, KT/v, URR, with increase in left atrial diameter (LAD) (p < 0.001, <0.001, <0.001,0.013) respectively while no significance in pulmonary hypertension, RAD, LVEDD (p value 1.000, 0.226,0.100) respectively. Patients with permanent catheter after 6 months had deterioration in TAST, serum albumin, URR, kt/v, hemoglobin, EF, LAD, RAD, LVEDD (p value <0.001, <0.001, 0.014, 0.010, 0.012, <0.001, 0.002, 0.001, <0.001) respectively. In comparing both groups: permanent catheter had significant deterioration in {hemoglobin, WBC, ferritin, TAST, albumin, EF} compared to AVF (p value <0.001, <0.001, <0.001, <0.001,0.001, <0.001) respectively, while no significance in LAD, RAD, LVEDD, pulmonary hypertension (p value 0.137, 0.435,0.052,0.315) respectively. Patients with Permanent catheter had a risk 10 times to have lower EF than AVF (odds ratio10.000). The EF after 6 months was positively correlated with URR, p value (0.028) and negatively correlated with dialysis duration p value (0.022) in AVF, while in permanent catheter was negatively correlated with-phosphorus, and potassium, p value (0.01, 0.048) respectively. Conclusion AVF is the preferred vascular access in heart failure for hemodialysis with better cardiac and dialysis outcome compared to permanent hemodialysis catheter. Adequatedialysis linked to positive effect on EF.