Abstract:
Arteriovenous fistula (AVF) is the preferred vascular access for
maintenance hemodialysis, yet the haemodynamic impact of AVF location on
cardiovascular parameters — including pulmonary artery pressure, right ventricular
function, and left ventricular remodelling — remains insufficiently characterised in
Central Asian cohorts. This prospective study enrolled 85 HD patients; Doppler
ultrasonography quantified PSV, EDV, RI, PI, and volumetric flow (Qa) across
radiocephalic (n=49), brachiocephalic (n=27), and prosthetic graft (n=9) subgroups,
with published echocardiographic evidence integrated to contextualise AVF
associated cardiac remodelling. Brachiocephalic AVF generated 63.8% higher Qa
than radiocephalic fistulas (1186 ± 312 vs. 724 ± 186 mL/min; p<0.001), greater
anastomotic PSV (196.8 vs. 148.2 cm/s), and lower RI (0.60 vs. 0.68); stenosis was
identified in 15.3% using the triad of PSV >400 cm/s, PSV ratio >2.0, and Qa <500
mL/min. This Qa gradient translates into differential cardiovascular loading — LV
dilatation, elevated LV mass index, impaired diastolic function (E/e'), and reduced
RV systolic function (TAPSE, FAC, SPAP) — supporting structured Doppler and
echocardiographic surveillance in all patients with proximal fistulas.
