title: High-output heart failure: how to define it, when to treat it, and how to treat it.
abstract: Although hemodialysis patients who initiate and maintain a permanent form of dialysis vascular access have improved all-cause and cardiovascular survival compared with those who use catheters, the presence of an arteriovenous fistula has been shown to have a short-term, adverse effect on cardiac function. Through its effect as a left-to-right extracardiac shunt, the arteriovenous fistula can increase cardiac workload substantially, and, in certain patients, result in a high-output state and resultant heart failure over time. Here we review the mechanisms by which dialysis arteriovenous access may promote the development of high-output cardiac failure in end-stage renal disease patients, describe risk factors for and the diagnosis of high-output heart failure, and suggest management strategies for patients who develop high-output heart failure.
authors.affiliation: Division of Nephrology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA. hwasse@emory.edu
authors.forename: Haimanot
authors.initials: H
authors.lastname: Wasse
authors.forename: M Salman
authors.initials: MS
authors.lastname: Singapuri
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors