Prevalence of Right Ventricular Dysfunction in relation to Type of Vascular Access in Chronic Hemodialysis Patients: Monocentric Study

Background: chronic renal failure (CRF) is associated with significantly increased morbidity and mortality. Chronic renal failure affects almost every system of the body and results in various functional and structural abnormalities. Life-sustaining haemodialysis (HD) requires durable vascular access (VA) to the circulatory system. An arteriovenous fistula is currently considered the gold standard access for hemodialysis, as it has lower risk for infection, lower tendency to thrombotic occlusion, greater blood flow, reduced treatment time and is less expensive to maintain than alternative vascular access methodologies. Patients on hemodialysis have several risk factors for developing PH: LV systolic and diastolic dysfunction, volume overload, endothelial dysfunction and sleep-discorded breathing. Aim of the Work: The aim of the current study was  the prevalence of right ventricular dysfunction in relation to type of the vascular access in chronic hemodialysis patients. Patients and Methods: this cross-sectional study was carried out on 100 subjects on regular hemodialysis more than six months duration, 62 males (62%) and 38 females (38%). The patients' age ranged between 24 and 76 years. They were selected from dialysis unit in Aswan health insurance hospital. All patients were subjected to the following: full history taking and clinical examination, vascular access examination (Types and patency), laboratory investigations. ECG for arrhythmias "AF, PVCs, Ischemic changes, LVH" and Echo parameters findings "RT. Vent. Systolic pressure, Rt. Vent. diastolic dysfunction, Rt. vent. dimensions, PHT & LVH). Results: percentage of right ventricular diastolic dysfunction was higher in patients of A-V fistula [47.5%] than [42.4 %] in cases of A-V graft and [33.3%] in patients with permanent catheter and there was significant statistical difference between right ventricular diastolic dysfunction and types of vascular access (p=0.043). The percentage of Rt. Ventricular diastolic dysfunction was higher in patients with low flux dialyzer membrane [83.3%] than in patients with high flux dialyzer [16.7%] but without significant statistical difference. There was no statistical difference between types of vascular access and attacks of recurrent of hypotension during dialysis session among chronic hemodialysis patients in the study. The percentage of Rt. Ventricular diastolic dysfunction was higher in patients with low flux dialyzer membrane [83.3%] than in patients with high flux dialyzer [16.7%] but without significant statistical difference. Conclusion: this study concluded a significant ventricular diastolicdysfunction in relation to type of vascular access in chronic hemodialysis patients. Vascular access type has a significant relationship to theincidence of pulmonary hypertension and Right ventricular systolic pressure (RVSP) in chronic hemodialysis patients.