Abstract

Background: The hemodynamic effects of a functioning haemodialysis arteriovenous fistula (AVF) can cause or exacerbate heart failure (HF). We investigated whether the presence of an AVF at time of kidney transplant (KT) is associated with de novo HF. Methods: This was an observational cohort study including adult patients who received a KT in the West of Scotland between 2010 and 2020. We evaluated the risk and associations of pretransplant factors with de novo HF, alone and as a composite cardiovascular (CV) outcome (including non-fatal myocardial infarction (MI), non-fatal stroke, de novo HF, and CV death). Multivariable proportional hazard regression and sensitivity analyses were used to identify independent correlates of the outcomes. Results: Among 1,330 included patients, the incident rate of de novo HF after transplantation was 58 (50-67) per 1,000 person-years in AVF patients (n=716) compared to 33 (27-41) per 1,000 person-years in non-AVF patients (n=614). De novo HF was associated with the presence of an AVF (adjusted hazard ratio [aHR] 2.14; 1.40-3.26), duration of dialysis (aHR 1.03 per year increase; 1.01-1.04), age at transplant (aHR 1.03 per year increase; 1.02-1.05), female sex (aHR 1.93; 1.40-2.65), and pretransplant diabetes (aHR 2.43; 1.48-4.01). The presence of an AVF was also associated with the composite CV outcome (aHR 1.91; 1.31-2.78). Conclusions: The presence of an AVF may be an under-recognised modifiable predictor of de novo HF posttransplantation.