The Clinical Relevance and Management of High-Flow Arteriovenous Access

Area of Science:

• Nephrology
• Cardiology
• Vascular Surgery

Background:

• Arteriovenous (AV) access is the preferred method for hemodialysis initiation, reducing infection and hospitalization risks.
• AV access creation can precipitate or worsen heart failure due to nonphysiologic increases in cardiac output.
• Potential cardiac complications include left ventricular hypertrophy, diastolic dysfunction, pulmonary hypertension, and high-output heart failure.

Purpose of the Study:

• To highlight the underrecognized cardiac complications associated with high-flow AV accesses.
• To emphasize the importance of monitoring AV access blood flow in hemodialysis patients.
• To advocate for collaborative management between nephrologists and vascular access experts.

Main Methods:

• Review of existing literature on AV access hemodynamics and cardiac function.
• Identification of risk factors and screening tools for high-output heart failure related to AV access.
• Discussion of management strategies for high-flow AV accesses.

Main Results:

• AV accesses with blood flow >1.5 L/min pose a high risk.
• Access flow exceeding 25%-30% of cardiac output increases the risk of high-output heart failure.
• A blood flow (Qa)/cardiac output (CO) ratio >0.30 is a suggested screening tool for cardiac evaluation.

Conclusions:

• High-flow AV accesses are associated with significant cardiac complications that are often overlooked.
• Regular monitoring and timely intervention are necessary to mitigate the risks of AV access-induced heart failure.
• Multidisciplinary collaboration is essential for optimal patient care and prevention of adverse cardiac events.