The relationship between arteriovenous fistula patency and clinical parameters among end stage renal di̇sease patients

Aim: Although arteriovenous fistulas are the most commonly used vascular access routes for hemodialysis, the factors affecting the success of the fistula still remain unclear. In this study, we aimed to investigate the effects of a number of cardiovascular parameters on fistulas as well as the clinical factors affecting fistula survival. Materials and methods: The data of 39 patients who underwent hemodialysis treatment via arteriovenous fistula and who underwent echocardiography at the time of first fistula opening were evaluated retrospectively. Primary / cumulative fistula failure rates and survival rates were statistically compared with clinical criteria. Results: Patients with arteriovenous fistula failure had lower ejection fraction rates, and fistula survival was negatively associated with ejection fraction. It was concluded that the ejection fraction was an independent predictor for the failure of the fistula and every 1% reduction in the ejection fraction increased the risk of fistula failure by 7%. Paradoxically, it was found that fistula survival is longer among the patients who had left atrial enlargement. The left atrial diameter was an independent predictor for fistula failure and the risk of fistula failure was 3.6 times lower in patients with left atrial enlargement. The success of primary fistula was associated with high hemoglobin levels and the presence of hypertension. High LDL levels were also associated with fistula failure. It has been concluded that the use of acetylsalicylate reduces the risk of fistula failure by 80% and that the risk of failure in patients not using acetylsalicylate increases 5-fold. Discussion: Although there are many studies in the literature on the effects of fistulas on cardiovascular system, no studies have examined the effects of cardiac performance and hypervolemia at fistula creation time on fistula success. This study demonstrates that left atrial dilatation, associated hypertension and preserved systolic functions positively affect fistula survival. Echocardiographic evaluation of patients with endstage renal failure and who are considered to create a fistula may be an important predictor and advantage in terms of fistula survival. Key words: End Stage Renal Disease, arteriovenous fistula, ejection fraction, left atrium diameter, fistula survival