Impact of High Flow Arteriovenous Fistula in Chronic Hemodialysis Patients on Cardiac Functions

:

Complications such as majorly dilated fistula, pulmonary hypertension, high output HF, dialysis-related steal syndrome, and DHIS have been associated with HFA [2].
Neither the ideal nor the normal access blood flow nor the exact blood flow (Qa) level that warrants consideration of an

Subjects
This cross-sectional study was done on 59 cases with chronic HD who have been

Study design
Cross-sectional study.

Statistical Methods
With

Results
The A significant positive association between Qa and PASP was observed.There was a statistically significant higher measure of PASP among the HFA group compared to the non-HFA group as seen in Table 4.

Discussion
The impact of access flow on cardiovascular functions has emerged as a critical concern because of the rising number of HD cases exhibiting extremely high AVF flow.
However, a specific characterization of the parameters that assess HFA and high-output HF has not been made based on good evidence.
Additionally, there are currently no established protocols for the management of individuals exhibiting elevated Qa and high-output HF.The probable under-recognized and neglected consequences of high-flow AVFs on CV morbidities are certain [5].
Among the study participants, 27% had HFA, according to our findings, when the cutoff value was 2000 ml/min.as well, falling from 52 to 41 mmHg [10].These data showed a strong relationship between Qa and SPAP, which supports our results.

Conclusion
High-flow arteriovenous fistula (HFA) is a common issue that occurs in around 27% of individuals undergoing chronic hemodialysis.
HFA was correlated with a significant effect on both systolic and diastolic functions of the heart.
HFA has been established by consensus.An arteriovenous fistula (AVF) was classified according to Vascular Access Society criteria as a high-flow fistula with an estimated cardiopulmonary recirculation (CPR) [Qa/cardiac output (CO)] more than 20% and a Qa amongst 1-1.5 L/min.A pragmatic cut-off point is a Qa > 2 L/min when an accurate description of an HFA is not available.This is because a Qa/CO > 20-30% raises the probability of HF in individuals with HD [3].In 2013, Ye et al. verified a treatment threshold of 2000 ml/min.They demonstrated that a Qa of AVF of more than 2000 ml/min greatly increases the risk of HF because of the greatly elevated cardiac output and reduced peripheral resistance [4].
and sexes, was gathered.B. Fundamental HD and vascular access details, involving vascular access creation date, dialysis treatment data, and physical results.Color Doppler ultrasonography (Mindray M6 system) was utilized to assess AVF flow (Qa), while Pulsed Doppler was utilized to measure the diameter of the AVF feeding vessel and the mean flow velocity.The algorithm that was accessible on the ultrasound machine was utilized to obtain the flow volume.Both Group A 43 patients (comprising non-HFA individuals whose Qa is below 2000 ml/min) and Group B 16 patients (comprised of HFA subjects whose Qa is more than 2000 ml/min) were formed from the study cohort according to their AVF flow.C. Transthoracic echocardiogram Utilizing Vivid E9, we conducted a traditional echocardiographic Doppler investigation as well as tissue Doppler imaging.The American Society of Echocardiography recommended that patients be placed in the left lateral position throughout end-expiration and that images be associated with single-lead electrocardiography (ECG).The standard measures were taken in the following views: apical long-axis, two-chamber, parasternal short-and longaxis, and apical four-chamber.The average of all measures recorded on three successive beats was utilized.No study was done more than 24 hours following an HD session.We assessed the following parameters [1]: LV dimensions and systolic performance: Measuring interventricular septal thickness, the left ventricular end-diastolic diameter (LVEDD), posterior wall thickness and left ventricular end-systolic diameter (LVESD), utilizing M-mode echocardiography to quantify the LV dimensions.We determined the LVEF.Utilizing the Simpson biplane techniques on the apical four and twochamber views, the volume of the LA was determined [3].Evaluation of left ventricular diastolic function: The findings were given after the trans-mitral pulsed-wave Doppler was recorded, the E and A wave peaks were measured, and the E/A ratio was computed.If the two-sided P value was smaller than 0.05, it was considered statistically significant.Inclusion criteria patients undergoing chronic HD at the Fayoum University Hospital Dialysis Unit through an AVF for a minimum of three months duration.Exclusion criteria previous cardiac diseases such as coronary artery disease (CAD), cardiac intervention, or history of HF with declined ejection fraction (HFrEF), AVF stenosis, Patients with volume overload, anemic patients and any septic condition were excluded by clinical assessment and basic sepsis parameters.

Table 1 :
Comparisons of demographic characters in variant examined groups.

Table 3 :
Comparisons of systolic function in both examined groups.

Table 4 :
Comparisons of PASP in different study groups.