Permanent Arteriovenous Fistula or Catheter Dialysis for Heart Failure Patients

Abstract

Heart failure (HF) is the most frequent cardiovascular disease associated with chronic kidney disease and represents a high risk for cardiovascular mortality in incident hemodialysis (HD) patients. This risk is especially high during the arteriovenous fistula (AVF) maturation period due to the marked hemodynamic changes related to the large increase in the blood flow and also within the first 120 days after HD inception because in this period the highest mortality rate occurs. When planning the vascular access for each incident HF patient, the risk of aggravating HF after AVF creation must be evaluated carefully alongside the risk of catheter-related complications, but avoiding a non-selective 'catheter first' approach for all these patients. HF patients classified within the New York Heart Association (NYHA) Class I-II and the American College of Cardiology/American Heart Association (ACC/AHA) Stage A-B could initiate HD through a distal arm AVF. High-flow brachial artery-based AVF creation must be avoided because it displays the highest risk of worsening the cardiac function. The decision for AVF creation or tunneled central catheter placement in HF patients classified within the NYHA Class III and the ACC/AHA Stage C must have been individualized according the degree of systolic and/or diastolic dysfunction. HF patients with significant reduction in systolic function (ejection fraction lower than 30%) or classified within the NYHA Class IV and the ACC/AHA Stage D, are candidates for tunneled catheter placement to start HD treatment.

The complex relationship among arteriovenous access, heart, and circulation

“…When planning vascular access in such patients, the risk of aggravating HF after AVF creation must be evaluated carefully alongside the risk of catheter‐related complications; a nonselective “fistula first” approach should be avoided. HF patients classified within the New York Heart Association (NYHA) class I‐II and the American College of Cardiology/American Heart Association (ACC/AHA) stage A‐B should initiate HD through an AVF but avoiding a high‐flow brachial artery‐based AVF because of the higher risk of worsening cardiac function . The access decision in HF patients classified as NYHA class III and the ACC/AHA stage C must be individualized according to the degree of systolic and/or diastolic dysfunction .…”

“…HF patients classified within the New York Heart Association (NYHA) class I‐II and the American College of Cardiology/American Heart Association (ACC/AHA) stage A‐B should initiate HD through an AVF but avoiding a high‐flow brachial artery‐based AVF because of the higher risk of worsening cardiac function . The access decision in HF patients classified as NYHA class III and the ACC/AHA stage C must be individualized according to the degree of systolic and/or diastolic dysfunction . HF patients with significantly reduced systolic function (ejection fraction lower than 30%) or classified as NYHA class IV and the ACC/AHA stage D are candidates to start HD treatment with a tunneled CVC .…”

“…The access decision in HF patients classified as NYHA class III and the ACC/AHA stage C must be individualized according to the degree of systolic and/or diastolic dysfunction . HF patients with significantly reduced systolic function (ejection fraction lower than 30%) or classified as NYHA class IV and the ACC/AHA stage D are candidates to start HD treatment with a tunneled CVC . They should then be re‐evaluated when stabilized on HD to detect an improvement in cardiac performance.…”

“…However, surveillance of Qa and cardiac parameters by echocardiography must be performed in HF patients to detect cardiac worsening . If the cardiomyopathy progresses and the heart continues to fail, an initially high CO may decrease to within the normal range.…”

Risk of Complications and Survival of Patients Dialyzed with Permanent Catheters

“…They are also used as bridging therapy for those who are waiting for a live donor transplant and for the maturation of the dialysis fistula formed. Dialysis catheters are also used in people with severe heart failure and respiratory failure, in whom fistula formation would be associated with exacerbation of the underlying disease [9][10][11][12][13][14]. Although the dialysis fistula is the gold standard, in various clinical situations, a catheter inserted into the venous system is selected for dialysis [7,15].…”