Incidence of arteriovenous fistula closure due to high-output cardiac failure in kidney-transplanted patients

Clin Transplant. Nov-Dec 2013;27(6):858-65. doi: 10.1111/ctr.12248. Epub 2013 Oct 7.

Abstract

Background: Some hemodialysis patients develop arteriovenous (AV) fistulas with high flows. This volume overload can result in high-output cardiac failure. To date, predisposing access flow rates are unknown.

Methods: A retrospective study of all kidney-transplant recipients at the Medical University of Innsbruck (MUI) from 2005 to 2010 included 797 patients with the following criteria: previous hemodialysis with a native AV fistula or a graft, sufficient function of the kidney transplant up to the time of the data analysis, and follow-up care at the MUI.

Results: Twenty-nine of the 113 patients (25.7%) needed an AV fistula closure, mostly because of symptoms of cardiac failure. The mean shunt flow in the intervention group was 2197.2 mL/min, whereas the mean shunt flow in the non-intervention group was only 850.9 mL/min. Shunt closures were most frequently made in patients with upper-arm shunts (41.7%).

Conclusion: The necessity of shunt closure is not a rarity. Patients who underwent an AV fistula ligature had high access flows with about 2200 mL/min. As the symptoms of cardiac failure greatly improved after shunt closure, patients with high access flow may benefit from such an intervention.

Keywords: arteriovenous fistula; high-output cardiac failure; kidney transplantation; shunt flow; shunt ligature.

MeSH terms

  • Arteriovenous Fistula / etiology*
  • Austria / epidemiology
  • Female
  • Follow-Up Studies
  • Heart Failure / diagnosis
  • Heart Failure / etiology*
  • Humans
  • Incidence
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Prognosis
  • Renal Dialysis / adverse effects*
  • Retrospective Studies
  • Risk Factors