Related Experiment Video
Updated: Jan 7, 2026
04:36
Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
2.5K
Hemodialysis Access Blood Flow and Cardiopulmonary Outcomes
Zahidul Mondal1, Mojgan Jalalzadeh1, Steve Khalil2
1Internal Medicine/Transplant Nephrology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.
Cureus
|January 2, 2026
Summary
High arteriovenous access flow in hemodialysis (>1.5-2.0 L/min) risks heart failure and pulmonary hypertension. Monitoring and managing this flow are crucial for preventing cardiovascular complications in ESRD patients.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- Arteriovenous (AV) access is essential for hemodialysis but can cause significant hemodynamic alterations.
- Excessive AV access flow can lead to maladaptive cardiovascular remodeling and complications like high-output heart failure (HOHF).
Purpose of the Study:
- To synthesize current literature on the hemodynamic impact of AV access in hemodialysis.
- To identify critical flow thresholds associated with cardiovascular complications.
- To outline diagnostic and management strategies for high-flow AV access.
Main Methods:
- Narrative synthesis of studies published between 2018-2025 from PubMed, Scopus, and Embase.
- Search terms included arteriovenous fistula, hemodialysis, high-output heart failure, pulmonary hypertension, and left-ventricular hypertrophy (LVH).
Main Results:
- AV access flow >1.5-2.0 L/min or >25-30% of cardiac output is linked to increased risk of LVH, HOHF, and pulmonary hypertension (PH).
- Duplex ultrasonography, ultrasound dilution, and echocardiography are key diagnostic tools.
- Right-heart catheterization confirms hemodynamic burden.
Conclusions:
- A critical flow threshold exists for AV access, guiding diagnosis and management of complications.
- Optimal management includes volume control, pharmacologic therapy, and flow reduction when necessary.
- Consistent surveillance and individualized access planning are vital for preventing cardiopulmonary remodeling and improving outcomes in ESRD patients.
Related Concept Videos
01:25Hemodialysis I: Introduction
1.2K
Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
1.2K
01:24Hemodialysis II: Procedure and Complications
558
DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
558
01:25Hemodialysis III: Nursing Management
681
The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
681
01:30Continuous Renal Replacement Therapy
722
Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
722
01:27Dialysis
1.1K
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
1.1K
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
464
Peritoneal dialysis (PD) is a medical process that removes waste products and excess fluid from the body using the peritoneal membrane as a natural filter.Peritoneal Dialysis MethodsSeveral methods can be used for peritoneal dialysis, including Acute Intermittent Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, and Automated Peritoneal Dialysis, also known as Continuous Cyclic Peritoneal Dialysis.Acute Intermittent Peritoneal Dialysis (AIPD) is used for patients with uremic...
464