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Heart failure and hemodialysis arteriovenous fistulae

Gerald A Beathard, MD, PhD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


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 [4]. 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".)


There are several cardiovascular effects of arteriovenous fistula (AVF) creation. These include:

Increased cardiac output

Decreased systemic peripheral resistance

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Literature review current through: Sep 2017. | This topic last updated: Jun 12, 2014.
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