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Clinical impact of left ventricular systolic dysfunction in patients undergoing dialysis access surgery

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Abstract

Background

An arteriovenous fistula (AVF) is the most frequently used dialysis access for haemodialysis. However, it can cause volume loading for the heart and may induce circulatory failure when performed in patients with low cardiac function. This study aimed to characterise patients with low cardiac function when initiating dialysis and determine how cardiac function changes after the dialysis access surgery.

Methods

We conducted a retrospective observational study at two centres incorporating 356 patients with end-stage kidney disease who underwent echocardiography before the dialysis access surgery.

Results

An AVF and a subcutaneously fixed superficial artery were selected in 70.4% and 23.5% of 81 patients with reduced/mildly reduced (< 50%) left ventricular ejection fraction (LVEF), respectively, and in 94.2% and 1.1% of 275 patients with preserved (≥ 50%) LVEF (p < 0.001), respectively. Follow-up echocardiography was performed in 70.4% and 38.2% of patients with reduced/mildly reduced and preserved LVEF, respectively, which showed a significant increase in LVEF (41 ± 9–44 ± 12%, p = 0.038) in patients with reduced/mildly reduced LVEF. LVEF remained unchanged in 12 patients with reduced/mildly reduced LVEF who underwent subcutaneously fixed superficial artery (30 ± 10–32 ± 15%, p = 0.527). Patients with reduced/mildly reduced LVEF had lower survival rates after surgery than those with preserved LVEF (p = 0.021 for log-rank).

Conclusion

The LVEF subcategory was associated with dialysis access selection. After the dialysis access surgery, LVEF was increased in patients with reduced/mildly reduced LVEF. These results may help select dialysis access for patients initiating dialysis.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

This work is funded by The Ministry of Education, Science, and Culture in Japan, 19K16986 (Masaaki Konishi).

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Authors and Affiliations

  1. Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan

    Sanae Saka & Nobuhito Hirawa

  2. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan

    Masaaki Konishi, Yasushi Matsuzawa, Kozo Okada, ** Kirigaya, Noriaki Iwahashi, Kiyoshi Hibi, Toshiaki Ebina & Kazuo Kimura

  3. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan

    Masaaki Konishi, Daisuke Kamimura, Hiromichi Wakui, Teruyasu Sugano, Tomoaki Ishigami & Kouichi Tamura

  4. Department of Laboratory Medicine, Yokohama City University Medical Center, Yokohama, Japan

    Toshiaki Ebina

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  1. Sanae Saka
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  2. Masaaki Konishi
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  13. Toshiaki Ebina
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  15. Kouichi Tamura
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Corresponding author

Correspondence to Masaaki Konishi.

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Conflict of interest

All authors have declared no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of Yokohama City University Hospital (approval number: B200700019) and the Ethics Committee of Yokohama City University Medical Centre (approval number: B20070041).

Informed consent

The requirement for written informed consent was waived due to the retrospective study design, and informed consent was obtained using the opt-out method.

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Saka, S., Konishi, M., Kamimura, D. et al. Clinical impact of left ventricular systolic dysfunction in patients undergoing dialysis access surgery. Clin Exp Nephrol 27, 374–381 (2023). https://doi.org/10.1007/s10157-023-02323-3

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  • DOI: https://doi.org/10.1007/s10157-023-02323-3

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