Background: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis but may be complicated by ischemic monomelic neuropathy (IMN) and adverse cardiac remodeling. Patients with neurological impairment may be particularly vulnerable, yet integrated data on neurovascular and cardiac outcomes in this subgroup are scarce. Methods: This analytical cross-sectional study was conducted from October 2023 to March 2024 at a tertiary center in Andhra Pradesh. Thirty-eight CKD patients undergoing upper-extremity AVF creation were enrolled: 19 with pre-existing neurological impairment (NI) and 19 controls. Baseline demographics, comorbidities, and echocardiographic parameters (LVEF, LVEDD, LV mass index, PASP) were recorded. Structured neurological evaluations were performed perioperatively, at 2 weeks, and 6 weeks; EMG/NCS was performed in symptomatic patients. Outcomes included incidence and reversibility of IMN, AVF maturation and complications, and cardiac changes at 6 weeks. Results: One NI patient (5.3%) developed IMN within 12 hours of brachiocephalic AVF creation and showed partial recovery at 6 weeks after ligation; no cases occurred in controls. AVF maturation rates were similar (84.2% NI vs 89.5% controls, p = 1.00). At 6 weeks, NI patients demonstrated significant increases in LV mass index [110 (98–122) → 118 (104–132) g/m², p = 0.04] and PASP [27 (22–31) → 30 (25–34) mmHg, p = 0.02], while controls showed no significant changes. Conclusion: Neurologically impaired CKD patients are at heightened risk for IMN and early cardiac remodeling following AVF creation, despite comparable access outcomes. Vigilant neurological and echocardiographic monitoring is warranted in this high-risk population.

Arteriovenous fistula, Renal dialysis, Chronic kidney disease, Peripheral nervous system diseases, Ischemic monomelic neuropathy, Cardiac remodeling