To close or not to close: Fistula ligation and cardiac function in kidney allograft recipients

Abstract

INTRODUCTION: Arteriovenous fistulas are a preferred access for hemodialysis. Subsequent hemodynamic changes in systemic circulation may cause heart failure. The general conclusions that can be drawn from the few available studies are that high-flow fistulas causing symptomatic heart failure should be subjected either to reconstruction or ligation. However, it is still unclear whether a well-functioning fistula should be ligated after successful kidney transplantation. OBJECTIVES: The aim of our study was to assess the effect of the fistula on heart function in patients after kidney transplantation. PATIENTS AND METHODS: The study included 18 patients after kidney transplantation. Five patients underwent fistula ligation for esthetic reasons; 4 fistulas thrombosed shortly after transplantation. A group of 9 patients with a patent fistula was matched for age and sex. Heart function was assessed by physical examination and echocardiography. RESULTS: The study group consisted of 6 women and 3 men, aged 32 to 64 years, with 6 forearm and 3 arm fistulas, and with hemoglobin levels ranging from 6.95 to 9.63 mmol/l. The control group consisted of 6 women and 3 men, aged 38 to 66 years, with 5 forearm fistulas and hemoglobin levels ranging from 7.32 to 9.25 mmol/l. Control echocardiography was performed in each patient 3 months after fistula closure and did not reveal any significant differences compared with baseline examination. CONCLUSIONS: Fistula ligation performed in a stable kidney allograft recipient does not seem to have a beneficial effect on cardiac function during short-term follow-up. Decision making should be cautious and balanced, because the creation of a new access may be extremely difficult and not always feasible. Copyright by Medycyna Praktyczna, Kraków 2012.