IYSC03 - Association Between Heart Failure and Arteriovenous Fistula Patency in Patients with End-stage Renal Disease on Hemodialysis

Objectives: Heart disease and chronic kidney disease are often comorbid conditions due to shared risk factors including diabetes and hypertension. However, the effect of congestive heart failure (CHF) on arteriovenous fistula and graft (AVF/AVG) patency rates is poorly understood. We hypothesize that heart failure may diminish blood flow to the developing AV fistula and worsen patency.

Methods: We conducted a single-institution retrospective review of 388 patients with ESRD who underwent AVF/AVG creation from 2015-2022. Patients were stratified by presence of pre-existing CHF, defined as clinical diagnosis with symptoms of CHF exacerbation plus systolic dysfunction (EF < 50%) or diastolic dysfunction on preoperative echocardiography. Baseline demographics, preoperative measures of cardiac function, and dialysis access-related surgical history were collected. Kaplan-Meier time-to-event analyses were performed for primary patency, primary assisted patency, and secondary patency using standard definitions for patency from the literature. We also assessed the correlation between preoperative LVEF and one-year morbidity and mortality outcomes.

Results: 180 patients (46%) had pre-existing CHF. Patients with CHF were more likely to be male and have comorbidities including diabetes, COPD, hypertension, and history of cerebrovascular accident. The groups were not significantly different in terms of prior fistula history (21.6% vs 19.4%, p=0.59), BMI (mean 28.9 vs 29.0, p=0.9), or type of AVF/AVG created (p=0.4) (Table 1). Lower preop LVEF correlated with higher myocardial infarction and chronic limb ischemia rates at 1 year (p < 0.05), and presence of CHF correlated with higher death, stroke, myocardial infarction, and hospitalization rates at 1 year (p < 0.05). No significant differences were found in loss of primary patency, primary assisted patency, or secondary patency over time for the CHF vs non-CHF group (log-rank p>0.1 for all measures). When stratified by preoperative LVEF, patients with lower LVEF appeared to have faster declines in patency over time, but this was not statistically significant (Figure 1).

Conclusions: In this seven-year experience of AVF/AVG creation, pre-existing heart failure is not associated with significant differences in patency rates at one year. Further stratification of heart failure by type (systolic versus diastolic dysfunction) and etiology (e.g., valvular dysfunction, hypertensive heart disease, cor pulmonale) is warranted to understand whether certain types or severity of heart failure may be more likely to influence AVF/AVG patency.