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Background Cardiovascular complications are leading cause of the death in hemodialysis patients. One of these complications is pulmonary hypertension which complicates chronic renal failure in 12–45% of cases and causes an increase in all-cause mortality of 2-3 folds in the dialysis population. Another complication is left ventricular hypertrophy which is a strong predictor of morbidity and mortality in patients with ESRD. Arteriovenous fistulas increase cardiac output and lead to significant increases in both the mass and the diameter of the left ventricular wall in the long-term duration. There is evidence that A-V fistula creation is a major risk factor for developing a new onset Congestive Heart Failure Aim of the Work Our study aimed to assess the relationship between blood flow volume of arteriovenous fistula (AVF) and its effect on the Pulmonary Artery Pressure (PAP) and the Left Ventricular (LV) dimensions and functions and to find out the cut off value of the AVF blood flow volume above which the cardiac dimensions and functions start to get affected. Methods and Results The study included 50 individuals selected from Internal Medicine and Nephrology outpatient clinics and inpatient wards at Ain Shams University Hospitals during the period from November 2016 until October 2018 who underwent full echocardiography studies once at the beginning of the study and once after 3 months and also underwent Duplex sonography on arteriovenous fistula to measure blood flow rate. The results showed that after 3 months the only significant changes were the ejection fraction (P-value of 0.029), the fractional shortening (P-value of 0.009), and the E/A ratio (p-value of 0.005). Also, the results showed a correlation between AVF blood flow volume and LV internal dimensions. Left ventricular end-diastolic diameter (LVEDD) and Left ventricular end-systolic diameter (LVESD) increased significantly in patients with AVF blood flow volume of 1010 ml/min or above and 1120 ml/min or above respectively. Surprisingly, PASP showed no statistically significant change in our study. Conclusion Our study concluded that high flow AVF affect cardiac dimensions and functions. We proved that a cut off value of AVF blood flow volume affecting LV dimensions and functions can be reached and in our study, a value of 1010 ml/min or above affected the LVEDD and a value of 1120 ml/min or above affected the LVESD. Surprisingly, in our study, the PASP did not show a positive correlation with AVF blood flow volume.

The Relationship between the Blood Flow Volume of the Arteriovenous Fistula and its Early Effect on the Pulmonary Artery Pressure and the Left Ventricular Dimensions and Functions