Benjamin K Dundon,1–3 Kim Torpey,3 Adam J Nelson,1 Dennis TL Wong,1,2 Rae F Duncan,1 Ian T Meredith,2 Randall J Faull,1,3 Stephen G Worthley,1,4 Matthew I Worthley1,41Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia; 2Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia; 3Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia; 4South Australian Health and Medical Research Institute, Adelaide, SA, Australia Aim: Arteriovenous fistula-formation remains critical for the provision of hemodialysis in end-stage renal failure patients. Its creation results in a significant increase in cardiac output, with resultant alterations in cardiac stroke volume, systemic blood flow, and vascular resistance. The impact of fistula-formation on cardiac and vascular structure and function has not yet been evaluated via "gold standard" imaging techniques in the modern era of end-stage renal failure care. Methods: A total of 24 patients with stage 5 chronic kidney disease undergoing fistula-creation were studied in a single-arm pilot study. Cardiovascular magnetic resonance imaging was undertaken at baseline, and prior to and 6 months following fistula-creation. This gold standard imaging modality was used to evaluate, via standard brachial flow-mediated techniques, cardiac structure and function, aortic distensibility, and endothelial function. Results: At follow up, left ventricular ejection fraction remained unchanged, while mean cardiac output increased by 25.0% (P