Related Experiment Video
Updated: Jul 12, 2026
08:21
Biventricular Assessment of Cardiac Function and Pressure-Volume Loops by Closed-Chest Catheterization in Mice
Published on: June 15, 2020
Vascular Access-Related Heart Failure: Pathophysiological Insights, Diagnostic Challenges, and Management Strategies
Enrico Prajiante Bertolino1, Abdullah Khan1, Ahmed A Sorour1
1Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Aortic Center, Cleveland Clinic, Cleveland, OH.
Kidney360
|July 9, 2026
Summary
Arteriovenous access-related heart failure (ARHF) is a serious complication in dialysis patients. Early recognition and management are crucial to improve outcomes for this high-risk group.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- Arteriovenous access-related heart failure (ARHF) is a critical complication in end-stage kidney disease (ESKD) patients undergoing hemodialysis.
- High-output heart failure is significantly associated with vascular access, posing a substantial mortality risk.
- ARHF is often underdiagnosed and mismanaged due to a lack of established clinical guidelines.
Purpose of the Study:
- To review the pathophysiology, diagnostic challenges, and management strategies for ARHF.
- To identify evidence gaps and propose methods for improving ARHF recognition and care.
- To provide clinical guidance for healthcare professionals managing ESKD patients with hemodialysis access.
Main Methods:
- Narrative review of existing literature on ARHF.
- Discussion of hemodynamic and non-hemodynamic factors contributing to ARHF.
- Analysis of diagnostic modalities including imaging and biomarkers.
- Outline of management strategies from prevention to intervention.
Main Results:
- Vascular access contributes to 23% of high-output heart failure cases.
- ARHF is associated with a 58% five-year mortality rate.
- Current diagnostic and management approaches are fragmented and lack standardization.
Conclusions:
- ARHF is an underrecognized cause of heart failure in ESKD patients.
- Improved diagnostic accuracy and standardized management protocols are essential.
- Further research is needed to address evidence gaps and optimize patient outcomes.
More Related Videos
Related Concept Videos
01:17Pathophysiology of Heart Failure
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
01:30Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
01:30Heart Failure VII: Nursing Interventions
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
01:29Heart Failure II: Pathophysiology
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
01:30Heart Failure IV: Classification and Diagnostic Evaluation
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
01:27Heart Failure I: Introduction
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...