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Updated: May 24, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Congestive heart failure in patients with advanced chronic kidney disease: association with pre-emptive vascular
Rocío Martínez-Gallardo1, Flavio Ferreira-Morong, Guadalupe García-Pino
1Hospital Infanta Cristina, Badajoz, Spain. rociomartinezgallardo@hotmail.com
Insights
Congestive heart failure (CHF) is common in pre-dialysis chronic kidney disease (CKD) patients. Creating an arteriovenous fistula (AVF) for dialysis access significantly increases CHF risk, alongside traditional factors.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- Congestive heart failure (CHF) is a frequent complication in patients with chronic kidney disease (CKD).
- CKD-related factors like anemia and fluid overload, in addition to traditional risk factors, contribute to CHF exacerbations.
- Understanding these factors is crucial for managing patients with advanced CKD.
Purpose of the Study:
- To determine the incidence of CHF in patients with stage 4-5 pre-dialysis CKD.
- To identify the main determinants of CHF in this patient population.
- To investigate the role of vascular access creation in CHF development.
Main Methods:
- A cohort of 562 patients with stage 4-5 pre-dialysis CKD was studied.
- Data included demographics, comorbidities, clinical and biochemical parameters.
- Arteriovenous fistula (AVF) creation and CHF development were primary outcomes, analyzed using logistic regression.
Main Results:
- 17% of patients developed acute decompensated CHF, with an incidence rate of 19 episodes per 1000 patient-years.
- Successful AVF creation significantly increased CHF risk (OR=9.54, P<.0001), independent of traditional risk factors.
- CHF episodes occurred a median of 51 days post-AVF creation, with unplanned dialysis initiation being more frequent in CHF patients.
Conclusions:
- Acute decompensated CHF is common in pre-dialysis CKD patients.
- Pre-emptive arteriovenous fistula (AVF) placement is a significant risk factor for CHF development.
- Management strategies should consider the impact of AVF creation on cardiac health in CKD patients.
Introduction:
Congestive heart failure (CHF) is a common complication in patients with chronic kidney disease (CKD). In addition to classical risk factors (e.g. age and pre-existing cardiac diseases), other potential reversible abnormalities linked to CKD such as anaemia, volume overload, or vascular access placement may also influence the incidence and severity of acute exacerbations of CHF.
Objective:
This study aims to determine the incidence and main determinants of CHF in a cohort of patients with stage 4-5 pre-dialysis CKD.
Patients And Method:
The study group consisted of 562 patients (mean age: 65 +/- 15 years, 260 females, 31% diabetics). Native arteriovenous fistulas (AVF) were created in 160 patients who chose haemodialysis as the initial technique for renal replacement therapy. The main outcome variables were: acute decompensated CHF (defined by standard criteria), dialysis initiation (planned and unplanned), and death before dialysis initiation. In addition to demographics, comorbidities, and clinical and biochemical data, AVF creation was also included as a potential determinant of CHF in multiple logistic regression models.
Results:
Ninety-five patients (17%) developed at least one episode of acute decompensated CHF, and the incidence rate was 19 episodes per 1000 patient-years. In addition to classical risk factors (age, female sex, obesity, diabetes, and previous history of CHF or coronary artery disease), creation of a successful AVF significantly increased the risk of CHF (OR=9.54, 95% CI: 4.84-18.81, P<.0001). In 47 out of 95 patients who developed CHF, a functioning AVF had previously been created, 92% of which were upper arm native AVF, with a median of 51 days between the surgical procedure and CHF episode. The mortality of patients with CHF was similar to that of the rest of the study patients, although unplanned dialysis initiation was significantly more frequent in those who developed CHF.
Conclusions:
Acute decompensated CHF episodes are common in pre-dialysis CKD patients. In addition to classical risk factors, pre-emptive AVF placement was strongly associated with the development of CHF.
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