Evaluation and management of heart failure caused by hemodialysis arteriovenous access
- Barry A Borlaug, MD
Barry A Borlaug, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Mayo Clinic College of Medicine
- Gerald A Beathard, MD, PhD
Gerald A Beathard, MD, PhD
- Clinical Professor
- University of Texas Medical Branch
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
- Section Editor
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
- Deputy Editors
- Alice M Sheridan, MD
Alice M Sheridan, MD
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
- Kathryn A Collins, MD, PhD, FACS
Kathryn A Collins, MD, PhD, FACS
- Deputy Editor — General Surgery
- Susan B Yeon, MD, JD, FACC
Susan B Yeon, MD, JD, FACC
- Deputy Editor — Cardiovascular Medicine
Creation of a hemodialysis arteriovenous (AV) access (via constructed native AV fistula or AV prosthetic graft) causes an acute decrease in systemic vascular resistance and a secondary increase in cardiac output [1,2]. The increased cardiac output is usually clinically insignificant but may rarely result in overt heart failure, particularly among patients with underlying heart disease. (See 'Pathogenesis' below.)
The pathogenesis, diagnosis, and management of AV access causing or exacerbating heart failure are presented in this topic review. High-output heart failure and the effects of hemodialysis AV access on pulmonary hypertension are discussed elsewhere. (See "High-output heart failure" and "Pulmonary hypertension in hemodialysis patients".)
A general discussion of myocardial dysfunction in the patient with end-stage renal disease (ESRD) is presented separately. (See "Myocardial dysfunction in end-stage renal disease".)
EPIDEMIOLOGY AND RISK FACTORS
The hemodynamic effects of a functioning hemodialysis AV access can cause or exacerbate heart failure . Most patients who develop heart failure from the hemodynamic demands of AV access have known cardiovascular disease and/or cardiovascular risk factors, but most hemodialysis patients have cardiovascular disease or cardiovascular risk factors. The high prevalence of heart disease among dialysis patients was illustrated by the Hemodialysis (HEMO) study; among the 1846 chronic hemodialysis patients enrolled, 40 percent had a history of heart failure, and 39 percent had a history of ischemic heart disease at baseline . (See "Risk factors and epidemiology of coronary heart disease in end-stage renal disease (dialysis)".)
Limited data are available on the risk of hemodialysis access worsening or precipitating heart failure [4-10]:To 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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- EPIDEMIOLOGY AND RISK FACTORS
- Acute changes
- Subacute and chronic changes
- CLINICAL MANIFESTATIONS
- MONITORING AND DIAGNOSIS
- Monitoring strategy
- Approach to diagnosis
- Examination and transient occlusion of AV access
- DIFFERENTIAL DIAGNOSIS
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS