Impact of Arteriovenous Fistula on Left Ventricular Workload in Patients with Kidney Transplantation

Background:The study evaluated the impact of kidney transplantation (KT) and arteriovenous fistula (AVF) for hemodialysis (HD) on left ventricular workload in patients with KT. Materials and Methods: We enrolled kidney transplant patients who underwent preoperative HD for renal replacement therapy.Workload of the left ventricle was calculated by multiplying mean arterial pressure by cardiac output.Cardiac output was calculated from echocardiographic measurements of left ventricular outflow diameter and left ventricular time integral.We compared the changes in left ventricular workload of patients with AVF (LLV A ), after KT (LLV B ), and after AVF ligation (LLV C ). Results: Among 324 patients who underwent hemodialysis before KT, we could obtain information concerning AVF ligation and echocardiagraphic data for 105 patients.LLV A and LLV B were compared in 32 patients, LLV B and LLV C were compared in 25 patients, and LLV A and LLV C were compared in 58 patients.On the paired t-test, mean LLV A and LLV B were 5.95 and 5.92 watts (p=0.942),mean LLV B and LLV C were 5.65 and 5.45 watts (p=0.494), and mean LLV A and LLV C were 6.30 and 5.51 watts (p=0.011)respectively.Conclusion: KT or AVF ligation alone may not be sufficient to control cardiac workload, and both are required.