Evaluation of alterations in cardiovascular structure and function in end-stage renal failure.
type: CreativeWork
description: Background: Chronic renal dysfunction is associated with myriad alterations in cardiovascular structure and function, resulting in markedly elevated rates of cardiac and vascular morbidity and mortality. Utilising advances in cardiovascular magnetic resonance imaging (CMR), we evaluated the cardiovascular sequelae of arterio-venous fistula formation in advanced chronic kidney disease, and the impact of elective arterio-venous fistula ligation following successful renal transplantation. Furthermore, we undertook to evaluate the diagnostic accuracy of dobutamine-stress CMR in the detection of haemodynamically‐significant coronary artery disease prior to renal transplantation. Finally, we invasively evaluated coronary endothelial function in the presence of advanced renal dysfunction, and compared this to subjects with preserved renal function. Methods / Results: Study 1: CMR was undertaken to evaluate cardiac structure and function, brachial artery endothelial function (as assessed by flow-mediated dilatation) and aortic distensibility in tweny‐four subjects at baseline, and 6‐months following, clinically indicated arterio‐venous fistula creation in preparation for the commencement of haemodialysis for end-stage renal failure. Following arterio‐venous fistula creation, mean cardiac output increased by 25.0% (p<0.0001), with substantial associated increases in left and right ventricular volumes, left and right atrial area and left ventricular mass (12.7% increase, p<0.0001). Peripheral endothelial function was significantly impaired at follow-up (9.0 ±9% vs. 3.0 ±6%, p=0.01). No significant change in aortic distensibility was identified. Study 2: Cardiac and vascular function were similarly assessed utilising CMR in eighteen subjects prior to, and 6‐months following, clinically indicated arterio-venous fistula ligation in the context of successful, stable renal transplantation. Following AVF-ligation, mean cardiac output fell by 15.6% (p=0.004), with significant attend…
abstract: Background: Chronic renal dysfunction is associated with myriad alterations in cardiovascular structure and function, resulting in markedly elevated rates of cardiac and vascular morbidity and mortality. Utilising advances in cardiovascular magnetic resonance imaging (CMR), we evaluated the cardiovascular sequelae of arterio-venous fistula formation in advanced chronic kidney disease, and the impact of elective arterio-venous fistula ligation following successful renal transplantation. Furthermore, we undertook to evaluate the diagnostic accuracy of dobutamine-stress CMR in the detection of haemodynamically‐significant coronary artery disease prior to renal transplantation. Finally, we invasively evaluated coronary endothelial function in the presence of advanced renal dysfunction, and compared this to subjects with preserved renal function. Methods / Results: Study 1: CMR was undertaken to evaluate cardiac structure and function, brachial artery endothelial function (as assessed by flow-mediated dilatation) and aortic distensibility in tweny‐four subjects at baseline, and 6‐months following, clinically indicated arterio‐venous fistula creation in preparation for the commencement of haemodialysis for end-stage renal failure. Following arterio‐venous fistula creation, mean cardiac output increased by 25.0% (p<0.0001), with substantial associated increases in left and right ventricular volumes, left and right atrial area and left ventricular mass (12.7% increase, p<0.0001). Peripheral endothelial function was significantly impaired at follow-up (9.0 ±9% vs. 3.0 ±6%, p=0.01). No significant change in aortic distensibility was identified. Study 2: Cardiac and vascular function were similarly assessed utilising CMR in eighteen subjects prior to, and 6‐months following, clinically indicated arterio-venous fistula ligation in the context of successful, stable renal transplantation. Following AVF-ligation, mean cardiac output fell by 15.6% (p=0.004), with significant attend…
author: Dundon, Benjamin Kane
keywords: end stage renal failure; cardiovascular imaging
date published: 2013
date modified: 2026-07-24T00:50:36Z
provider: University of Adelaide
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Adelaide

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property ID: Handle
value: http://hdl.handle.net/2440/83535