Impact of Arteriovenous Fistula on Flow States in the Evaluation of
Aortic Stenosis among ESKD Patients on Dialysis
Abstract
Introduction An arteriovenous fistula (AVF) in patients with
end-stage kidney disease (ESKD) can influence flow states. We sought to
evaluate if assessment of aortic stenosis (AS) by transthoracic
echocardiographic (TTE) differs in the presence of AVF compared to other
dialysis accesses in patients on dialysis. Methods We
identified consecutive ESKD patients on dialysis and concomitant AS from
a single center between January 2000 and March 2021. We analyzed TTE
parameters of AS severity (velocities, gradients, aortic valve area
[AVA]) and hemodynamics (cardiac output [CO], valvuloarterial
impedance [Zva]) and compared AS parameters in patients with AVF
versus other dialysis access. Results The cohort included 94
patients with co-prevalent ESKD and AS; mean age 66 years, 71% male;
43% Black, 24% severe AS. Dialysis access: 53% AVF, 47% others. In
the overall cohort, no significant differences were noted between AVF
vs. non-AVF in AVA/CO/Zva, but with notable subgroup differences. In
mild AS, CO was significantly higher in AVF vs. non-AVF (6.3 vs. 5.2
L/min; p=0.04). In severe AS, Zva was higher in the AVF vs. non-AVF (4.6
vs. 3.6 mmHg/ml/m 2). With increasing AS severity in
the AVF group, CO decreased, coupled with increase in Zva, likely
counterbalancing the net hemodynamic impact of the AVF.
Conclusion Among ESKD patients with AS, TTE parameters of flow
states and AS severity differed in those with AVF versus other dialysis
accesses and varied with progression in severity of AS. Future
longitudinal assessment of hemodynamic parameters in a larger cohort of
co-prevalent ESRD and AS would be valuable.