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Kidney Week

Abstract: FR-PO494

Arterio-Venous Shunt and Right Heart Function and Structure

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Wing, Richard E., University of Rochester Medical Center, Rochester, New York, United States
  • Rao, Nikhila Sri, University of Rochester Medical Center, Rochester, New York, United States
  • Rao, Nilesh Sai, University of Rochester Medical Center, Rochester, New York, United States
  • Grace, Eliane S., University of Rochester Medical Center, Rochester, New York, United States
  • Wang, Matthew, University of Rochester Medical Center, Rochester, New York, United States
  • Le, Thu H., University of Rochester Medical Center, Rochester, New York, United States
Background

Emerging evidence suggests that right ventricular dysfunction (RVD) is a major determinant of adverse health outcomes. Data regarding the effect of AV shunt (AVS) placement on right heart function (RHF) and right heart structure (RHS) are sparse.

Methods

We conducted a cross-sectional study on patients with advanced CKD or ESRD who were followed by URMC nephrology faculty. We identified subjects who underwent an ambulatory echocardiogram within 90 days of AVS creation (Pre) and another ambulatory echocardiogram at least six months after AVS creation (Post). Original echocardiographic images were re-read to focus on RHF and RHS. Measures of RHF included: Tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC). Measures of RHS included length and diameter in systole and diastole. Changes between first and second echocardiograms were assessed. Continuous variables were analyzed by paired T-test. Categorical variables were analyzed by the McNemar test.

Results

Between 1/1/2010 and 12/31/2022, 1319 advanced CKD or ESRD patients under our care underwent at least one echocardiogram and/or underwent AVS construction. Thus far we have identified 39 subjects who met the criteria of having Pre and Post ambulatory echocardiograms that have interpretable measurements for the right heart. Selected subject characteristics are summarized in table 1. Selected echocardiographic changes are summarized in table 2.

Conclusion

Changes consistent with worsening RHF and RHS are observed in patients who underwent AVS construction. The observed population deterioration may have been attenuated due to survival bias as only subjects with two ambulatory echocardiograms at least six months apart were considered for analysis. Future efforts include adding a comparator group of failed AVS creation.