Echocardiographic Changes in Chronic Kidney Disease Patients Before and After Arteriovenous Fistula Creation: A Prospective Study of Cardiac Remodeling

Muhammad Zaryab Haider; Ranjith Mule; Tabassum; Muhammad Anees Ur Rehman; Qurat Ul Ain; Muhammad Irfan Jamil; Tayyaba Arooj Mufti; Muhammad Ahsan Butt; Fnu Anam; Fnu Shahzeen

doi:10.7759/cureus.89693

Echocardiographic Changes in Chronic Kidney Disease Patients Before and After Arteriovenous Fistula Creation: A Prospective Study of Cardiac Remodeling

Cureus. 2025 Aug 9;17(8):e89693. doi: 10.7759/cureus.89693. eCollection 2025 Aug.

Authors

Muhammad Zaryab Haider^{1

2}, Ranjith Mule³, Tabassum⁴, Muhammad Anees Ur Rehman^{5

2}, Qurat Ul Ain^{6

7}, Muhammad Irfan Jamil⁸, Tayyaba Arooj Mufti⁹, Muhammad Ahsan Butt^{8

10}, Fnu Anam¹¹, Fnu Shahzeen¹²

Affiliations

¹ Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, PAK.
² Acute Internal Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, GBR.
³ Emergency Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, GBR.
⁴ Acute Medicine, Blackpool Victoria Hospital, Blackpool, GBR.
⁵ Acute Internal Medicine, Quaid-E-Azam Medical College, Bahawalpur, PAK.
⁶ Medicine, M. Islam Medical and Dental College, Gujranwala, PAK.
⁷ Medicine/Cardiology, University of Health Sciences Lahore, Lahore, PAK.
⁸ Nephrology, Lahore General Hospital, Lahore, PAK.
⁹ Cardiology/Medicine, Akhtar Saeed Medical and Dental College, Lahore, PAK.
¹⁰ Medicine, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, GBR.
¹¹ Medicine, Sayed Abdullah Shah Institute of Medical Sciences, Sehwan, PAK.
¹² Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK.

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.

Keywords: arteriovenous (av) fistula; cardiac echo; cardiac remodelling; chronic kidney disease (ckd); lvef (left ventricular ejection fraction).