"Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with End-Stage Renal Disease (ESRD). It accounts for half of the deaths and one-third of hospitalizations of dialysis patients." Locatelli F et al, Nephrol Dial Transplant 2000; 15(Suppl 5): 69-80.
High flow in an AV access can produce life-threatening cardiac complications for ESRD patients. The precise volume flow level that will induce high-output failure or extremity ischemia will vary with each patient, based on co-morbidities, especially the degree of cardiac disease and peripheral arterial disease. For patients at risk based on such pre-existing conditions, the widespread consensus (evidence-based) is that patients with access flows of 2 L/min or higher should be tested and followed for these complications -- and have a flow-reduction procedure performed at the earliest signs of cardiac complications or extremity ischemia.
With the high prevalence of cardiac disease in the hemodialysis population, an insidious and silent access flow as a major cause or contributor to a potentially deadly cardiac complication, is often overlooked. Therefore, it is critically important for the practitioner to be aware of the relationship between access flow and cardiac failure, since many of these high-flow patients will have morbidity and mortality.
Best Practice: Cardiovascular complications in ESRD patients must be averted or reduced through periodic exams by the patient’s nephrologist, supported by routine cardiac function screening and tests administered by the hemodialysis staff.