Does a fistula have an adverse impact on cardiac problems?

[Stoday]

I was reading that the radial artery has a normal flow rate of 20-30 ml/min, but when an anastomosis is formed by connection to the cephalic vein the flow rate jumps initially to 200-300 ml/min. When the fistula is mature, the flow rate further increases to 600-1200 ml/min.

This must have an impact on the heart because the resting blood flow rate is ~5000 ml/min at rest. The fact that over 50% of deaths of ESRD patients are attributable to cardiac causes suggests that the impact is adverse. Nevertheless, an AV fistula is considered the gold standard for access.

As I see it, there are two possibilities, viz: 1) The extra work on the heart strengthens it, so, like exercise, it makes you better off or
2) The extra work puts a load on the heart that makes an adverse cardiac event more likely.

I've no idea which is the right answer. I can't find anything that answers this question. Any views?

[galvo]

Dunno. I hope it's 1.

[Rerun]

It is not natural and that is why my body kept trying to shut it off.  Don't you think they could come up with something better?

               

[okarol]

I think there was a discussion with meinuk about this but cannot locate it. Here's another related thread http://ihatedialysis.com/forum/index.php?topic=18037.0

[mogee]

I was reading that the radial artery has a normal flow rate of 20-30 ml/min, but when an anastomosis is formed by connection to the cephalic vein the flow rate jumps initially to 200-300 ml/min. When the fistula is mature, the flow rate further increases to 600-1200 ml/min.

This must have an impact on the heart because the resting blood flow rate is ~5000 ml/min at rest. The fact that over 50% of deaths of ESRD patients are attributable to cardiac causes suggests that the impact is adverse. Nevertheless, an AV fistula is considered the gold standard for access.

As I see it, there are two possibilities, viz: 1) The extra work on the heart strengthens it, so, like exercise, it makes you better off or
2) The extra work puts a load on the heart that makes an adverse cardiac event more likely.

I've no idea which is the right answer. I can't find anything that answers this question. Any views?

You are absolutely right.  And unfortunately adverse cardiac events are more likely.  One of my friends has a fistula that grew huge and had a flow of over 2000ml/min.  It was stressing her heart and causing it to enlarge.  She had her fistula surgically revised to about 1000ml/min and her shortness of breath abated and her heart is functioning normally.

[boswife]

Wow!!  hadnt thought on this one before...  So, how do we find out how fast it is in ours???

[Desert Dancer]

I really need to avoid these threads about fistulas. They're crazy-making. 

[mogee]

Wow!!  hadnt thought on this one before...  So, how do we find out how fast it is in ours???

Fistula flow rates are measured with a Transonic study.  You must be hooked up, and the entire test takes only minutes.  The results are instant.  Unfortunately, the Transonic device itself is very expensive and not all dialysis facilities have one.  My hospital has two large in-centre units as well as a home hemo unit so there is a nurse whose only job is performing Transonic studies.

[Bruno]

I'm with DD, I wish I hadn't opened this thread...no bloody kidneys and now my friendly fistula (who I've been looking after like a brother, by the way) is threatening me with a heart attack. What a bummer.

[MomoMcSleepy]

I've wondered about this, too, but when I ask health care workers I get carys answers and people telling me I'm young and strong, and have no heart problems.....yeah, and I want to keep it that way!   

[jackdempsey]

When the doctors look at me they get horny over the veins in my arms and I will always get one of them that says

"oh those veins would make a great fistula"

It's a great way to sum up their way of thinking.

They work for a lot of people, but the nightmares that are associated with bad fistulas is not something I want.

A Fistula in a bad situation, in the OperatingRoom = death, very quickly.