HEMODYNAMIC SIGNIFICANCE OF ARTERIOVENOUS FISTULA LOCATION IN HEMODIALYSIS PATIENTS: DOPPLER FLOW ASSESSMENT AND CARDIOVASCULAR IMPLICATIONS

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.