title: Incidence of arteriovenous fistula closure due to high-output cardiac failure in kidney-transplanted patients.
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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Nephrology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Tabea
authors.initials: T
authors.lastname: Schier
authors.forename: Georg
authors.initials: G
authors.lastname: Göbel
authors.forename: Claudia
authors.initials: C
authors.lastname: Bösmüller
authors.forename: Ingrid
authors.initials: I
authors.lastname: Gruber
authors.forename: Martin
authors.initials: M
authors.lastname: Tiefenthaler
mesh_terms: D001164:Arteriovenous Fistula / Q000209:etiology*; D001317:Austria / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: arteriovenous fistula; high-output cardiac failure; kidney transplantation; shunt flow; shunt ligature