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Evaluation and management of heart failure caused by hemodialysis arteriovenous access

Barry A Borlaug, MD
Gerald A Beathard, MD, PhD
Thomas A Golper, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editors
Alice M Sheridan, MD
Kathryn A Collins, MD, PhD, FACS
Susan B Yeon, MD, JD, FACC


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".)


The hemodynamic effects of a functioning hemodialysis AV access can cause or exacerbate heart failure [1]. 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 [3]. (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]:

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Literature review current through: Nov 2017. | This topic last updated: Oct 27, 2017.
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