High-output cardiac failure secondary to a large arteriovenous fistula: a persistent threat to the dialysis and kidney transplant patient

Khreiss, Mohamad; Haddad, Fady; Musallam, Khaled M.; Medawar, Walid; Daouk, Majida; Khalil, Ismail

doi:10.1093/ndtplus/sfn211

Cited by 8 publications

(8 citation statements)

References 7 publications

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“…Qa ≥2 l/minute and Qa/CO (cardio‐pulmonary ratio) of ≥20% also accurately predicted the occurrence of CF. This fits in well with the available case reports of HF where fistula flows have between 23% and 57% of the CO . CF rarely occurs with normal fistula flow .…”

Section: High Output Cardiac Failuresupporting

confidence: 91%

Complications of a High‐flow Access and Its Management

Sequeira

Tan

2015

Seminars in Dialysis

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A high-flow access has been defined as one with a flow >1-1.5 l/minute or as one where the access flow is >20% of the cardiac output. Although it may be asymptomatic, it can be associated with cardiopulmonary complications, aneurysms, central vein stenosis and the distal hypoperfusion ischemic syndrome in some patients. The decision for surgical intervention should be made after careful medical optimization especially in patients with high output cardiopulmonary compromise. In this review, we present a summary of current knowledge about the pathophysiology of a high-flow fistula, followed by a concise, comprehensive synopsis of current medical and surgical therapy.

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Section: High Output Cardiac Failuresupporting

confidence: 91%

Complications of a High‐flow Access and Its Management

Sequeira

Tan

2015

Seminars in Dialysis

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“…The available case reports of HFA reported Qa/CO ranges between 23 and 57% 8, 9, 13, 14, 15, 16, 17. HF rarely occurs with normal fistula flow 8, 9…”

Section: Discussionmentioning

confidence: 99%

Effect of high flow arteriovenous fistula on cardiac function in hemodialysis patients

Saleh

Kilany

Keddis

et al. 2018

The Egyptian Heart Journal

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BackgroundVascular access for hemodialysis (HD) with an inappropriately high flow may underlie the onset of high output heart failure (HOHF).The aim of this study was to determine the prevalence of high flow access (HFA) in chronic HD patients, and to determine its effects on cardiac functions.MethodsThis cross sectional study was conducted on 100 chronic hemodialysis patients through arteriovenous fistula (AVF). The study cohort was subdivided into 2 groups based on AVF flow: Group A (Non-HFA group with Qa < 2000 ml/min), and Group B (HFA group with Qa ≥ 2000 ml/min). AVF flow (Qa) was assessed using Color Doppler ultrasonography. Transthoracic echocardiography was performed for all patients to assess cardiac dimensions and functions.ResultsPrevalence of HFA among study population was 24%. Mean AVF Qa was 958.63 ± 487.35 and 3430.13 ± 1256.28 ml/min, for group A and B respectively. The HFA group demonstrated a significant dilatation in LV dimensions and volumes and significantly larger LA volume as compared to non-HFA group. A significantly lower LV ejection fraction [EF] was also observed in group B with a mean value of 57.32 ± 6.19% versus 62.90 ± 5.76%. A significant association between HFA group and high Qa/cardiac output (CO) ratio (≥20%) was also observed.ConclusionHFA is a prevalent hemodialysis vascular access problem. HFA was associated with dilated LV dimensions, impaired LV systolic function. High Qa/CO ratio (≥20%) was an independent predictor of high output heart failure (HOHF) in our study population.

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“…Furthermore, it is known that cardiac output increases by 10–17% after the creation of an arterio-venous fistula 31 , 32 . Cases of high-output heart failure due to the overload caused by arterio-venous fistulas or grafts have previously been reported 33 , 34 .…”

Section: Discussionmentioning

confidence: 99%

Impact of Systemic Volume Status on Cardiac Magnetic Resonance T1 Mapping

Antlanger

Kammerlander

Duca

et al. 2018

Sci Rep

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Diffuse myocardial fibrosis is a key pathophysiologic feature in heart failure and can be quantified by cardiac magnetic resonance (CMR) T1 mapping. However, increases in myocardial free water also prolong native T1 times and may impact fibrosis quantification. Thus far, the impact of systemic patient volume status remains unclear. In this study, native T1 time by CMR was investigated in hemodialysis (HD) patients (n = 37) and compared with healthy controls (n = 35). Volume status was quantified by bioimpedance spectroscopy and correlated with CMR T1 time. While no differences between HD patients and controls were present with regard to age (p = 0.180), height (p = 0.535), weight (p = 0.559) and left ventricular (LV) ejection fraction (p = 0.273), cardiac size was significantly larger in HD patients (LV end-diastolic volume 164 ± 53 vs. 132 ± 26 ml, p = 0.002). Fluid overloaded HD patients had significantly longer native T1 times than normovolemic HD patients and healthy controls (1,042 ± 46 vs. 1,005 ± 49 vs. 998 ± 47 ms, p = 0.030). By regression analysis, T1 time was significantly associated with fluid status (r = 0.530, p = 0.009, post-HD fluid status). Our data strongly indicate that native CMR T1 time is significantly influenced by systemic volume status. As fluid overload is common in patients with cardiovascular diseases, this finding is important and requires further study.

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High-output cardiac failure secondary to a large arteriovenous fistula: a persistent threat to the dialysis and kidney transplant patient

Cited by 8 publications

References 7 publications

Complications of a High‐flow Access and Its Management

Complications of a High‐flow Access and Its Management

Effect of high flow arteriovenous fistula on cardiac function in hemodialysis patients

Impact of Systemic Volume Status on Cardiac Magnetic Resonance T1 Mapping

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