Abstract
AIM AND BACKGROUND: Arteriovenous fistula (AVF) creation remains the preferred vascular access for hemodialysis in patients with advanced chronic kidney disease (CKD). However, the hemodynamic burden imposed by an AVF may lead to progressive cardiac remodeling, with implications for long-term cardiovascular morbidity. This study aimed to evaluate structural and functional cardiac changes following AVF creation in stage 4 and 5 CKD patients over a six-month follow-up using serial echocardiography. METHODS: This prospective study initially included 150 patients; however, 105 patients with complete data were analyzed at the six-month follow-up. Transthoracic echocardiography was performed at three time points: before AVF creation, at three months, and six months post-creation. RESULTS: At three months, transient improvements were noted in the left ventricular ejection fraction (53.16 ± 5.21% to 56.23 ± 4.85%, p<0.001), global longitudinal strain (GLS) (-15.21 ± 0.91% to -15.38 ± 0.89%, p<0.001), and diastolic indices. However, by six months, progressive cardiac remodeling was evident with significant increases in the left ventricular mass index (+20.63 ± 6.04 g/m², p<0.001), left ventricular end-diastolic diameter and left ventricular end-systolic diameter, and left atrial volume index (+7.50 ± 1.23 mL/m², p<0.001). Diastolic function deteriorated (early-to-atrial filling velocity ratio (E/A) and early diastolic to mitral annular velocity ratio (E/e'), p<0.001), pulmonary artery systolic pressure increased by +9.90 ± 1.42 mmHg, tricuspid annular plane systolic excursion declined (-2.07 ± 0.44 mm), and tricuspid regurgitation velocity rose (+0.38 ± 0.14 m/s). GLS showed a subclinical decline (-0.38 ± 0.11%, p<0.001). CONCLUSION: AVF creation results in a biphasic cardiac response with early adaptive changes followed by significant structural and functional deterioration by six months.