Heart failure and hemodialysis arteriovenous fistulae
- Gerald A Beathard, MD, PhD
Gerald A Beathard, MD, PhD
- Clinical Professor
- University of Texas Medical Branch
Cardiovascular disease is a well-recognized and important source of mortality in patients with chronic kidney disease (CKD) [1-3]. Data collected by the United States Renal Data System indicated that the risk of death in a dialysis patient with heart failure is 0.33, 0.46, and 0.57 at 12, 24, and 36 months after initiating dialysis, respectively . Although the presence of an arteriovenous fistula (AVF) has an adverse effect on cardiac function, the exact role of the vascular access in contributing to this morbidity is unclear.
The effect of AVFs on cardiovascular dynamics and the management of AVFs causing and/or exacerbating heart failure are presented in this topic review. An overview of myocardial dysfunction in the patient with end-stage renal disease (ESRD) is presented separately. (See "Myocardial dysfunction in end-stage renal disease".)
EFFECTS OF ARTERIOVENOUS FISTULA CREATION
There are several cardiovascular effects of arteriovenous fistula (AVF) creation. These include:
●Increased cardiac output
●Decreased systemic peripheral resistanceTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EFFECTS OF ARTERIOVENOUS FISTULA CREATION
- Increased cardiac output and high-output cardiac failure
- Decreased peripheral vascular resistance and effects on cardiac mechanics
- Pulmonary hypertension
- DECISIONS CONCERNING ACCESS PLACEMENT
- Our approach
- PROSPECTIVE MONITORING AND DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS