Effect of preoperative heart failure on arteriovenous access patency and prognosis in patients on hemodialysis.

BACKGROUND

The risk of arteriovenous (AV) access failure is associated with hemodynamic factors, clinical factors, or technical issues. Although several studies have shown the detrimental effects of AV access on heart function, few studies have assessed whether heart function affects AV access patency. We investigated the impact of cardiac function on AV access patency. Additionally, we evaluated the influence of heart failure (HF) on the prognosis of patients on dialysis.

METHODS

Patients who underwent dialysis and had echocardiographic reports between 2011 and 2013 were retrospectively included. Left ventricular ejection fraction (LVEF) was used to measure cardiac function. Data on demographics, clinical features, and technical factors associated with AV access surgery were collected. Univariate and multivariate analyses were performed to evaluate the risk factors for AV access patency loss and the prognosis of patients on dialysis.

RESULTS

During the study period, 395 patients initiated on dialysis underwent echocardiography. In multivariate analysis, older age (hazard ratio (HR) 1.02 (1-1.03),  = 0.028), smoking (HR 2.05 (1.19-3.53),  = 0.01), lower LVEF (HR 0.98 (0.97-1),  = 0.015), and graft use (HR 2.29 (1.47-3.58),  = 0.001) were significant risk factors for primary patency loss. Regarding secondary patency loss, lower LVEF (HR 0.98 (0.96-1),  = 0.035) was the sole risk factor. In multivariate analysis, risk factors for cardiac events (acute coronary syndrome and aggravation of HF) in patients on dialysis were age (HR 1.06 (1.04-1.09),  = 0.001), diabetes (HR 2.46 (1.31-4.63),  = 0.005), pre-existing coronary artery disease (HR 2.84 (1.57-5.14),  = 0.001), and HF (HR 1.93 (1.05-3.56),  = 0.036).

CONCLUSION

Decreased cardiac function adversely affects the primary and secondary patency of AV access, but its impact is limited. Additionally, HF is associated with future cardiac events in dialysis patients. However, HF is not independently associated with patient survival.