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Therapy of heart failure in hemodialysis patients

Charles A Herzog, MD
William L Henrich, MD, MACP
Alfred K Cheung, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


Systolic or diastolic ventricular dysfunction can lead to clinically evident heart failure (HF), even when the hemodialysis patient is at or near "dry weight." Myocardial disease and cardiovascular drugs can also reduce hemodynamic reserve, making the patient more vulnerable to episodes of hypotension during dialysis.

The following discussion will present the therapeutic approach to the hemodialysis patient with chronic HF.


To be able to follow clinical practice guidelines on the treatment of congestive HF, a clinician (eg, nephrologist) must be able to assign a functional class to an individual patient. Classification schemes in HF (such as New York Heart Association [NYHA] functional class) do not account for the dynamic/tidal nature of volume status in hemodialysis patients. It would not be unusual for the same patient to have a higher (more severe) NYHA class 3 before hemodialysis session compared with shortly after. A proposed functional classification scheme, specifically for dialysis patients, was developed by the Acute Dialysis Quality Initiative (ADQI) XI Workgroup [1]. The three elements of the proposed HF staging system are:

Standardized echocardiographic evidence of structural and/or functional cardiac abnormalities (table 1)

Dyspnea occurring in the absence of primary lung disease, including isolated pulmonary hypertension (ie, not due to elevation in pulmonary capillary wedge pressure)

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Literature review current through: Nov 2017. | This topic last updated: May 10, 2017.
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