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Beyond the Vascular Access: Unveiling the Cardiovascular Impact of Dialysis Access Flow Rates Publisher Pubmed



Moradmand M1 ; Mahmoudabadi FD1 ; Javanbakht M2 ; Ghorbani H3 ; Mohebbi M1 ; Aghajani S4 ; Bayat R1 ; Makooie M5 ; Shadravan MM6 ; Mishan M7 ; Movahedi H1 ; Rostamkalaei S8 ; Salimi S9 ; Nodoushan SMHT10
Authors
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Authors Affiliations
  1. 1. Department of General Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Nephrology and Urology Research Center, Clinical Science Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
  3. 3. Surgical Research Center, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  6. 6. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  7. 7. Valiasr Hospital, Abadan University of Medical Sciences, Khorramshahr, Iran
  8. 8. Department of Cardiology, Shahid Rajaee Hospital, Iran University of Medical Sciences, Tehran, Iran
  9. 9. Department of Plastic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  10. 10. Faculty of Medicine, Iran University of Medical Sciences, Shohadaye Salamat Hospital, Malard, Iran

Source: Journal of Cardiothoracic Surgery Published:2025


Abstract

Objective: To investigate the impact of arteriovenous fistula (AVF) and arteriovenous graft (AVG) flow rates on cardiac function and blood pressure in hemodialysis patients, comparing changes before and after vascular access creation and assessing differences between high and non-high flow access groups. Methods: This prospective, observational study included 80 hemodialysis patients (43 males), all of Iranian ethnicity, at a university-affiliated referral hospital in Tehran, Iran. Flow rates (Qa) of vascular accesses were measured using Color Doppler ultrasonography (Acuson Sequoia system). Echocardiographic parameters, including systolic blood pressure, ejection fraction (EF), and left ventricular end-diastolic dimension (LVEDD), were assessed at baseline and six months post-intervention. Data were analyzed using paired t-tests and Pearson correlation coefficients. Results: Following vascular access creation, a significant decrease in systolic blood pressure was observed (156.48 ± 18.04 mmHg to 141.42 ± 15.82 mmHg, p < 0.001), along with a notable decline in EF (57.18% ± 6.51 to 50.31% ± 4.99, p < 0.001), and an increase in LVEDD (4.43 ± 0.27 cm to 5.51 ± 0.26 cm, p < 0.001), suggesting potential cardiovascular burden in high-flow access patients. Patients with high-flow access exhibited greater cardiovascular burden, likely due to increased cardiac output demands and risk of high-output heart failure. No significant differences in cardiac outcomes were observed between proximal and distal AVFs or upper and lower limb AVGs. Conclusions: These findings underscore the need for proactive cardiovascular monitoring, particularly in patients with high-flow vascular access, to prevent potential complications such as high-output cardiac failure. Routine Doppler ultrasonography and echocardiographic assessments should be integrated into clinical practice to identify high-risk patients and guide timely interventions. © The Author(s) 2025.
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