“My fistula has a strong thrill. Is that a burden on my heart?” Some dialysis patients ask this at follow-up visits. In August 2026, the Journal of Vascular Surgery (JVS) published a retrospective study from a single US medical center that followed 201 patients with high-flow vascular access and looked at how their echocardiograms changed over the years after the access was created.
reference: PubMed: PMID 42648561
Why was this study done?
Once a fistula or graft is created, the vessel gradually widens and blood flow increases. That is what makes the access usable for dialysis. In some people, however, the flow becomes particularly high; the authors call this high-flow vascular access. How the heart’s structure changes after long-term exposure to such high flow has not been well understood, so the authors looked back at echocardiograms taken before and after access creation in patients with high-flow access.
How was the study done?
- Participants: all patients with high-flow vascular access at a single medical center over a 10-year period
- Definition of high flow: access blood flow above 2,000 mL per minute
- Data: demographics and clinical data from medical records, plus echocardiograms taken before and at different time points after access creation
- Analysis: paired analysis to compare before and after; univariable and multivariable Cox regression for death, ventricular dilation and ventricular dysfunction
Main results
| Measure | Result |
|---|---|
| Number of patients | 201 |
| Average age | 57 years |
| Access blood flow (median) | 2,338 mL per minute (interquartile range 2,189–2,787) |
| Population | 31% women, 68% African American |
| Access type | Upper-arm access 87%, brachial artery–basilic vein 42%, autogenous (native vessel) 89% |
| At 6 months | Left atrial volume and left ventricular end-diastolic volume worsened |
| At 1–3 years | Most other measures worsened significantly, especially right ventricular systolic pressure; right and left ventricular dilation and dysfunction reached statistical significance |
| At 5 years | Left ventricular ejection fraction fell significantly (P < .01) |
| Left ventricular mass index | No significant change (P = .34) |
| Association with early death | Any right ventricular dilation: hazard ratio 2.83 (P = .007); right ventricular systolic dysfunction: hazard ratio 2.36 (P = .017). Both were independently associated with early death |
Among these patients with flow above 2,000 mL per minute, echocardiographic changes began about six months after access creation and became more pronounced at one to three years. Enlargement or reduced function of the right heart was associated with earlier death.
The authors’ conclusion
The authors conclude that cardiac remodeling in patients with high-flow access can be seen as early as six months, and that after one to three years of exposure, echocardiographic markers related to heart failure gradually worsen. They stress that access flow and cardiac structure should be followed routinely so that changes can be found early; worsening right ventricular measures were independently associated with the risk of early death and need close observation.
Limitations of this study
- Single-center, retrospective study: the data came from existing medical records, not from a follow-up plan designed in advance.
- No control group: the study included only patients with high-flow access and did not compare them with patients who have ordinary access flow, so it cannot tell how much of the cardiac change was caused by high flow and how much by dialysis and kidney disease itself.
- Not stated in the abstract: whether echocardiograms were done on a fixed schedule or only when symptoms appeared; how many patients completed the exam at each time point; how “early death” was defined; and the confidence intervals of the hazard ratios. This article does not speculate.
- Describes changes only, no intervention tested: the study did not assess whether measures such as adjusting access flow would change outcomes.
- Different population and health system: the study was done in the United States, with 68% African American patients and 87% upper-arm access, which differs from the makeup and access practices of patients in Taiwan.
What this means for dialysis patients
The takeaway is that a stronger access flow is not necessarily better, and the strength of the thrill alone does not tell you the flow. Access flow has to be measured by tests such as ultrasound; patients cannot tell the exact number by touch and do not need to adjust anything on their own. The practical approach is to follow up on your access regularly as arranged by your care team, and to tell your doctor and the dialysis unit if your condition changes (for example, getting short of breath or tired more easily than before). Whether further heart tests are needed is for your care team to decide as a whole.
This article is an introduction to academic literature, based on the original abstract and publicly available information. The results describe statistics for a group of patients; they do not predict an individual’s treatment outcome and are not a guarantee of results. Please discuss your own evaluation and treatment with your care team.
Frequently asked questions (FAQ)
Q: My fistula has a very strong thrill. Does that mean I have high-flow access?
A: Not necessarily. How strong the thrill feels cannot be converted directly into a flow rate. This study used a measured flow above 2,000 mL per minute. If you want to know your own flow, ask your care team to arrange a test.
Q: Will high-flow access definitely harm my heart?
A: This is a single-center retrospective study with no control group. It can only say that echocardiographic changes were observed in this group of high-flow patients. It does not prove that everyone will develop them, and it cannot separate how much is due to dialysis itself.
Q: Do I need regular echocardiograms?
A: The authors recommend routine follow-up of the access and cardiac structure, but the actual tests and how often they are done should be decided by your care team based on your history and condition.
Original article and links
Khan A, et al. Long-term echocardiographic trajectories after high-flow vascular access creation. J Vasc Surg. 2026 (Aug, online ahead of print).
DOI: 10.1016/j.jvs.2026.08.018 | PubMed: PMID 42648561
Further reading: related articles on this site
If you would like to learn more about related topics, you may find these earlier articles helpful:
- Ultrasound Examination of Dialysis Access: Why Regular Follow-up Matters
- Steal Syndrome
- Vessels Growing Larger With Dialysis? Understanding Aneurysms
- How to Care for Your Own Access
- Arteriovenous Fistulas & Grafts
- Hemodialysis Access
If you have questions about choosing an access, surgical planning or follow-up after surgery, you are welcome to contact the care team. You can also read our Hemodialysis Access education section to learn more about dialysis access.
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