Kidney Week

Abstract: PUB224

In a Heartbeat: Rapid Assessment of Cardiac Output after Arteriovenous Fistula Creation Using Point-of-Care Ultrasonography

Session Information

• Publication Only

Category: Dialysis

• 803 Dialysis: Vascular Access

Authors

• Shah, Nasir A., University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia

Nasir A. Shah, MBBS, MS, MSc, FASN

• Cochran, Blake, University of New South Wales School of Biomedical Sciences, Sydney, New South Wales, Australia

Blake Cochran, PhD

• Endre, Zoltan, University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia

Zoltan Endre, MBBS, PhD, FASN

• Barber, Tracie, University of New South Wales School of Mechanical and Manufacturing Engineering, Sydney, New South Wales, Australia

Tracie Barber, PhD

• Erlich, Jonathan H., University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia

Jonathan H. Erlich, MBBS, PhD

Background

Up to 44% of patients treated with haemodialysis develop heart failure. Though numerous observational studies have found associations between arteriovenous fistula (AVF) flow and cardiac function, the exact contribution of AVF flow on the incidence of heart failure remains unclear. The aim of this pilot study was to use point-of-care ultrasound (POCUS) to assess cardiac output (CO) after arteriovenous fistula creation.

Methods

POCUS was used to assess left ventricular outflow tract (LVOT) diameter and LVOT velocity time integral before and after AVF creation. These values were used to calculate CO. Measurements were taken preoperatively, within 1 hour of AVF creation, and after AVF maturation.

Results

Nine patients were included in the study. In all patients, there was no significant difference in CO between measurements performed prior to AVF creation and those taken immediately post-operatively. Six patients had repeat CO measurements after AVF maturation. Four patients had an increase in CO and 2 had a decrease. Overall, there was no significant between-group difference when comparing pre-operative CO to measurements taken after AVF maturation (p = 0.77).

Conclusion

This small study using POCUS to assess CO showed some patients increase and others decrease their CO after AVF creation. Individual patient data suggests the possibility of a functional difference where some patients are unable to increase their CO after AVF creation. Whether this inability to mount a compensatory change in CO is associated with additional changes to cardiac imaging, biochemical markers of heart failure, or clinical outcomes such as incident heart failure and all-cause morbidity/mortality needs to be examined further.