Hemodialysis access type is associated with blood pressure variability and echocardiographic changes in end-stage renal disease patients

Arteriovenous fistula (AVF) strategy has been recommended in clinical guidelines for a long time due to the survival benefits associated with it. However, the underlying mechanism still needs to be explored. This retrospective cohort study included 611 patients who received hemodialysis in West China Hospital Medical Center between January 1, 2014 and December 31, 2014. Patient characteristics, dialysis parameters, and 1-year blood pressure records were collected at baseline. Echocardiographic changes and clinical outcomes were assessed during the 59-month follow-up. Our study showed that fistulas were associated with lower long-term systolic blood pressure (SBP) standard deviation (SD) (P<0.0001), lower long-term SBP residual metric (P<0.0001), and lower intradialytic SBP residual (P=0.001). Fistulas were also associated with a higher but non-significant proportion of the newly developed left ventricular (LV) hypertrophy (8.29% vs. 6.78%, P=0.116) and increased LV volume (8.29% vs. 4.52%, P=0.139), as well as a lower proportion of the newly developed left ventricular ejection fraction (LVEF) dysfunction (1.62% vs. 2.82%, P=0.586). After a median of 59-month follow-up, catheter group showed a higher risk of cardiovascular events (hazard ratio [HR] 1.21; 95% confidence interval [95%CI] 1.01-1.52), all-cause infection (HR 1.25; 95%CI 1.07-1.47), and access-related infection (HR 2.88; 95%CI 1.76-4.68). However, the advantage of fistulas only retained in low-albumin subgroup (serum albumin<40g/l) except for access-related infections. Our results suggested the possible attribution of BPV and other patient factors to fistula-associated survival benefits.