Abstract 9915: Impact of Arteriovenous Fistula and Non-Physiological Flow States in the Evaluation of Aortic Stenosis Among End-Stage Kidney Disease Patients on Dialysis

Introduction: Aortic stenosis (AS) progresses rapidly and unpredictably in ESKD and is an independent risk factor for mortality. Making an accurate diagnosis and assessing severity of AS on TTE is critical to inform management decisions. TTE parameters of AS severity could be adversely impacted by presence of an arteriovenous fistula (AVF) and resultant non-physiological flow states in ESKD. We aim to evaluate prevalence of non-physiological flow states in patients with ESKD and AS with AVF vs. other dialysis access types. We hypothesized that TTE parameters vital to accurate determination of severity of AS will defer in ESKD patients with AVF compared to other types of dialysis access. Methods: In this retrospective observational study, we identified unique ESKD patients on dialysis and concomitant AS from a single center between 1/1/2000 to 1/1/2021. Severity of AS was defined per 2014 AHA/ACC guidelines. We analyzed the TTE parameters of AS severity according to dialysis access modality. Aortic valve area (AVA) was determined by the continuity equation. Results: We included 94 patients; mean age 66 yrs, 71% male; 43% black, 40% white. Severe AS was present in 18%, moderate in 41% and mild in 41%. Fifty-three percent of patients had AVF, 17% arteriovenous graft, 15% peritoneal dialysis catheter, and 15% central venous access catheter. TTE parameters of flow state and AS severity did not demonstrate any significant differences across different dialysis access modalities. (Table 1) The results were similar after adjusting for AS severity grades. Conclusions: Among ESKD patients with AS, flow states and TTE parameters of AS severity were not different in the presence of an AVF compared to other dialysis access modalities. This study provides reassurance that conventional TTE parameters, including peak velocity, mean gradient, and AVA used to estimate AS severity can be utilized reliably in dialysis patients with AVF since non-physiological flow states were not prevalent.