On 2014 Nov 02, Swapnil Hiremath commented:

This is a nice, and elegant study which reiterates the potential effects of the av fistula creation on cardiac remodeling. However, given the survival benefit with AVF (as compared to central venous catheters) these results should be interpreted with caution. Another confounding factor perhaps not considered in this study is the effect of worsening kidney function over time: over the 6 months of study, the kidney function of some of these patients would have worsened, and in some cases accompanied by salt and water retention - or worsening hypertension. It would have been helpful to present these details (and/or control for them). Indeed, the absence of controls (i.e. patients who may not have had an AVF created) is a significant limitation. Lastly, the authors do not cite previous work from our group which used echocardiograms (and not CMR), with slightly greater numbers and longer follow up.

On 2014 Nov 02, Swapnil Hiremath commented:

This is a nice, and elegant study which reiterates the potential effects of the av fistula creation on cardiac remodeling. However, given the survival benefit with AVF (as compared to central venous catheters) these results should be interpreted with caution. Another confounding factor perhaps not considered in this study is the effect of worsening kidney function over time: over the 6 months of study, the kidney function of some of these patients would have worsened, and in some cases accompanied by salt and water retention - or worsening hypertension. It would have been helpful to present these details (and/or control for them). Indeed, the absence of controls (i.e. patients who may not have had an AVF created) is a significant limitation. Lastly, the authors do not cite previous work from our group which used echocardiograms (and not CMR), with slightly greater numbers and longer follow up.