The Effect of AVF on Cardiovascular Disease
It is well-known that arteriovenous fistulas (AVFs) are the preferred vascular access in hemodialysis patients, mainly because they decrease morbidity and mortality. Despite advances in the field of hemodialysis, the mortality rate still remains high, with cardiac complications as a leading cause followed by infections. We will discuss the cardiovascular effect of AVF below.
AVFs have significant effects on cardiac functions, relating predominantly to the increase in preload – the initial stretching of the cardiac muscle cells prior to contraction – and cardiac output (CO) – the volume of blood being pumped by the heart. The effect on cardiac output is complex and is caused mainly due to the change of flow in the blood system. The change of flow is mainly due to: (1) the presence of an AVF shunts the blood flow from the high resistance arterial system into the low resistance venous system, thus increasing venous flow rate; and (2) the presence of an AVF decreases arterial impedance that lessens the left ventricular afterload (the end load against which the heart contracts to eject blood).
Other possible effects on the heart include:
- left ventricular hypertrophy
- myocardial ischemia
- valvular heart disease
It is important to keep in mind that in most cases it is hard to estimate the exact contribution of an AVF to cardiac dysfunction in hemodialysis patients because many of these patients have significant pre-existing myocardial, valvular, or coronary heart disease.
AVFs are associated with lower mortality and are the gold standard for most patients with ESRD needing dialysis. They are, in addition, tolerated well by most patients. However, the potentially effects of AVFs, particularly in the context of pre-existing heart disease, should not be underestimated. For patients with pre-existing heart disease, a thorough cardiac assessment should be performed prior to placing an AVF.
In any case of pain or discomfort you should immediately report to your health care provider.
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