Abstract: FR-PO527
A Change of Heart: Effect of High-Flow Arteriovenous Fistulas on Cardiovascular Outcomes, a Systematic Review and Synthesis without Meta-Analysis (SWiM)
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Shah, Nasir A., University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
- Hind, Morgan Elizabeth Kate, The University of Notre Dame Australia School of Medicine, Fremantle, Western Australia, Australia
- Endre, Zoltan, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
- Cochran, Blake, University of New South Wales School of Biomedical Sciences, Sydney, New South Wales, Australia
- Barber, Tracie, University of New South Wales School of Mechanical and Manufacturing Engineering, Sydney, New South Wales, Australia
- Erlich, Jonathan H., University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia
Background
Heart failure is a common cardiovascular condition in patients on haemodialysis. Case reports and a selection of studies have found associations between arteriovenous fistula (AVF) flow and heart failure, but the exact relationship remains unclear. The aim of this study was to describe the relationship between AVF flow and cardiac outcomes.
Methods
A comprehensive search of the PubMed, EMBASE, and Cochrane databases was used to identify observational studies and randomized controlled trials reporting clinical, echocardiographic, or biomarker effects of AVF flow on cardiac outcomes. Study heterogeneity made meta-analysis not feasible. Synthesis without meta-analysis (SWiM) was performed using vote counting of direction of effect as the primary outcome.
Results
The initial search strategy retrieved 3622 studies. After screening, 100 studies were analysed including a total of 8414 patients. A positive direction of effect was observed with cardiac output (29/34 studies), BNP (13/18 studies), ANP (2/3 studies), left ventricular hypertrophy and left ventricular mass (10/15 studies), left ventricular mass index (11/19 studies), left atrial volume index (10/12 studies) and incident heart failure or heart failure symptoms (21/25 studies). A neutral direction of effect was observed with ejection fraction (29/41 studies), E/A ratio (13/13 studies), E/E’ ratio (8/11 studies), tricuspid annular plane systolic excursion (6/9 studies), and measures of pulmonary hypertension (13/26 studies). A negative direction of effect was observed for all-cause mortality (3/7 studies).
Conclusion
This systematic review and synthesis without meta-analysis showed a positive direction of effect between AVF flow and several cardiovascular outcomes, but an inverse relationship between AVF flow and mortality. The methodological heterogeneity of studies highlights the need for well-designed prospective research with standardised definitions of high flow AVFs and measures for reporting of cardiovascular outcomes.