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 resistance
- Muntner P, He J, Hamm L, et al. Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 2002; 13:745.
- Bibbins-Domingo K, Lin F, Vittinghoff E, et al. Renal insufficiency as an independent predictor of mortality among women with heart failure. J Am Coll Cardiol 2004; 44:1593.
- Shlipak MG, Stehman-Breen C, Vittinghoff E, et al. Creatinine levels and cardiovascular events in women with heart disease: do small changes matter? Am J Kidney Dis 2004; 43:37.
- US Renal Data System. USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda, MD 2012.
- Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966; 275:1089.
- Ahearn DJ, Maher JF. Heart failure as a complication of hemodialysis arteriovenous fistula. Ann Intern Med 1972; 77:201.
- MacRae JM, Pandeya S, Humen DP, et al. Arteriovenous fistula-associated high-output cardiac failure: a review of mechanisms. Am J Kidney Dis 2004; 43:e17.
- Pandeya S, Lindsay RM. The relationship between cardiac output and access flow during hemodialysis. ASAIO J 1999; 45:135.
- Sandhu JS, Wander GS, Gupta ML, et al. Hemodynamic effects of arteriovenous fistula in end-stage renal failure. Ren Fail 2004; 26:695.
- Lazarides MK, Staramos DN, Panagopoulos GN, et al. Indications for surgical treatment of angioaccess-induced arterial "steal". J Am Coll Surg 1998; 187:422.
- Korsheed S, Eldehni MT, John SG, et al. Effects of arteriovenous fistula formation on arterial stiffness and cardiovascular performance and function. Nephrol Dial Transplant 2011; 26:3296.
- Iwashima Y, Horio T, Takami Y, et al. Effects of the creation of arteriovenous fistula for hemodialysis on cardiac function and natriuretic peptide levels in CRF. Am J Kidney Dis 2002; 40:974.
- Basile C, Lomonte C, Vernaglione L, et al. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients. Nephrol Dial Transplant 2008; 23:282.
- Bednarek-Skublewska A, Jóźwiak L, Przywara S, et al. [Acute cardiac failure secondary to brachiocephalic arteriovenous fistula in patient on chronic haemodialysis]. Pol Arch Med Wewn 2004; 112:1221.
- Chapman F, Blackmur JP, Fotheringham J, et al. An uncommon cause of pleural effusions in a dialysis patient. Lancet 2012; 380:186.
- Engelberts I, Tordoir JH, Boon ES, Schreij G. High-output cardiac failure due to excessive shunting in a hemodialysis access fistula: an easily overlooked diagnosis. Am J Nephrol 1995; 15:323.
- Young PR Jr, Rohr MS, Marterre WF Jr. High-output cardiac failure secondary to a brachiocephalic arteriovenous hemodialysis fistula: two cases. Am Surg 1998; 64:239.
- Wijnen E, Keuter XH, Planken NR, et al. The relation between vascular access flow and different types of vascular access with systemic hemodynamics in hemodialysis patients. Artif Organs 2005; 29:960.
- Chemla ES, Morsy M, Anderson L, Whitemore A. Inflow reduction by distalization of anastomosis treats efficiently high-inflow high-cardiac output vascular access for hemodialysis. Semin Dial 2007; 20:68.
- GUYTON AC, SAGAWA K. Compensations of cardiac output and other circulatory functions in areflex dogs with large A-V fistulas. Am J Physiol 1961; 200:1157.
- Mitchell GF, Parise H, Vita JA, et al. Local shear stress and brachial artery flow-mediated dilation: the Framingham Heart Study. Hypertension 2004; 44:134.
- Dammers R, Tordoir JH, Welten RJ, et al. The effect of chronic flow changes on brachial artery diameter and shear stress in arteriovenous fistulas for hemodialysis. Int J Artif Organs 2002; 25:124.
- Buckley MG, Sethi D, Markandu ND, et al. Plasma concentrations and comparisons of brain natriuretic peptide and atrial natriuretic peptide in normal subjects, cardiac transplant recipients and patients with dialysis-independent or dialysis-dependent chronic renal failure. Clin Sci (Lond) 1992; 83:437.
- Naruse M, Takeyama Y, Tanabe A, et al. Atrial and brain natriuretic peptides in cardiovascular diseases. Hypertension 1994; 23:I231.
- Nishikimi T, Futoo Y, Tamano K, et al. Plasma brain natriuretic peptide levels in chronic hemodialysis patients: influence of coronary artery disease. Am J Kidney Dis 2001; 37:1201.
- McCullough PA, Sandberg KR. Sorting out the evidence on natriuretic peptides. Rev Cardiovasc Med 2003; 4 Suppl 4:S13.
- Ori Y, Korzets A, Katz M, et al. Haemodialysis arteriovenous access--a prospective haemodynamic evaluation. Nephrol Dial Transplant 1996; 11:94.
- van der Mark WA, Boer P, Cramer MJ, Blankestijn PJ. Decreased access resistance in haemodialysis patients with upper arm arteriovenous fistulae. Nephrol Dial Transplant 2008; 23:2105.
- Yigla M, Abassi Z, Reisner SA, Nakhoul F. Pulmonary hypertension in hemodialysis patients: an unrecognized threat. Semin Dial 2006; 19:353.
- Abassi Z, Nakhoul F, Khankin E, et al. Pulmonary hypertension in chronic dialysis patients with arteriovenous fistula: pathogenesis and therapeutic prospective. Curr Opin Nephrol Hypertens 2006; 15:353.
- Nakhoul F, Yigla M, Gilman R, et al. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol Dial Transplant 2005; 20:1686.
- Dolmatch BL, Gray RJ, Horton KM. Will iatrogenic pulmonary embolization be our pulmonary embarrassment? Radiology 1994; 191:615.
- Yigla M, Nakhoul F, Sabag A, et al. Pulmonary hypertension in patients with end-stage renal disease. Chest 2003; 123:1577.
- Yigla M, Keidar Z, Safadi I, et al. Pulmonary calcification in hemodialysis patients: correlation with pulmonary artery pressure values. Kidney Int 2004; 66:806.
- Archer S, Rich S. Primary pulmonary hypertension: a vascular biology and translational research "Work in progress". Circulation 2000; 102:2781.
- Jeffery TK, Morrell NW. Molecular and cellular basis of pulmonary vascular remodeling in pulmonary hypertension. Prog Cardiovasc Dis 2002; 45:173.
- Stamler JS, Loh E, Roddy MA, et al. Nitric oxide regulates basal systemic and pulmonary vascular resistance in healthy humans. Circulation 1994; 89:2035.
- Chen YF, Oparil S. Endothelial dysfunction in the pulmonary vascular bed. Am J Med Sci 2000; 320:223.
- Giaid A, Yanagisawa M, Langleben D, et al. Expression of endothelin-1 in the lungs of patients with pulmonary hypertension. N Engl J Med 1993; 328:1732.
- Wever R, Boer P, Hijmering M, et al. Nitric oxide production is reduced in patients with chronic renal failure. Arterioscler Thromb Vasc Biol 1999; 19:1168.
- Morris ST, Jardine AG. The vascular endothelium in chronic renal failure. J Nephrol 2000; 13:96.
- Vaziri ND. Effect of chronic renal failure on nitric oxide metabolism. Am J Kidney Dis 2001; 38:S74.
- Amin M, Fawzy A, Hamid MA, Elhendy A. Pulmonary hypertension in patients with chronic renal failure: role of parathyroid hormone and pulmonary artery calcifications. Chest 2003; 124:2093.
- Nitta K, Akiba T, Uchida K, et al. The progression of vascular calcification and serum osteoprotegerin levels in patients on long-term hemodialysis. Am J Kidney Dis 2003; 42:303.
- Smits HF, Van Rijk PP, Van Isselt JW, et al. Pulmonary embolism after thrombolysis of hemodialysis grafts. J Am Soc Nephrol 1997; 8:1458.
- Harp RJ, Stavropoulos SW, Wasserstein AG, Clark TW. Pulmonary hypertension among end-stage renal failure patients following hemodialysis access thrombectomy. Cardiovasc Intervent Radiol 2005; 28:17.
- Mauri JM, Vela E, Clèries M. Development of a predictive model for early death in diabetic patients entering hemodialysis: a population-based study. Acta Diabetol 2008; 45:203.
- Bradbury BD, Fissell RB, Albert JM, et al. Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol 2007; 2:89.
- Keuter XH, Kooman JP, Habets J, et al. Effect of upper arm brachial basilic and prosthetic forearm arteriovenous fistula on left ventricular hypertrophy. J Vasc Access 2007; 8:296.
- NKF-K/DOQI Clinical Practice Guidelines For Vascular Access. Clinical Practice Guideline 2: Selection and placement of hemodialysis access. Am J Kidney Dis 2008; 48(Suppl 1):S248.
- Ishani A, Collins AJ, Herzog CA, Foley RN. Septicemia, access and cardiovascular disease in dialysis patients: the USRDS Wave 2 study. Kidney Int 2005; 68:311.
- NKF-K/DOQI Clinical Practice Guidelines For Vascular Access. Clinical Practice Guideline 4: Detection of access dysfunction: monitoring, surveillance, and diagnostic testing. Am J Kidney Dis 2008; 48(Suppl 1):S248.
- Sidawy AN, Spergel LM, Besarab A, et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 2008; 48:2S.
- Velez-Roa S, Neubauer J, Wissing M, et al. Acute arterio-venous fistula occlusion decreases sympathetic activity and improves baroreflex control in kidney transplanted patients. Nephrol Dial Transplant 2004; 19:1606.
- Bos WJ, Zietse R, Wesseling KH, Westerhof N. Effects of arteriovenous fistulas on cardiac oxygen supply and demand. Kidney Int 1999; 55:2049.
- Unger P, Wissing KM, de Pauw L, et al. Reduction of left ventricular diameter and mass after surgical arteriovenous fistula closure in renal transplant recipients. Transplantation 2002; 74:73.
- Miller GA, Hwang WW. Challenges and management of high-flow arteriovenous fistulae. Semin Nephrol 2012; 32:545.
- Goel N, Miller GA, Jotwani MC, et al. Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) for treatment of dialysis access-associated steal syndrome. Kidney Int 2006; 70:765.
- Pascual J, Martins J, Bouarich H, et al. Sudden death after arteriovenous fistula ligation in a renal transplant patient. Ann Vasc Surg 2008; 22:134.
- 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