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Background <p>Hemodialysis remains the predominant renal replacement procedure and, in most cases, requires the creation of an arteriovenous fistula (AVF). This nonphysiological connection between the arterial and venous circulations induces relevant hemodynamic alterations. Shortly after creation of an AVF the heart is exposed to an increased volume load, which can result in both acute adaptations and long-term structural changes.</p> Methods <p>A&#xa0;systematic review of recent clinical studies and observational data on cardiac and renal effects of an AVF was performed. Imaging modalities (echocardiography, cardiac magnetic resonance imaging, MRI), biomarkers (brain natriuretic peptide, BNP, N‑terminal pro BNP, NT-proBNP) and hemodynamic measurements, including shunt flow (Qa) and its relation to cardiac output were evaluated.</p> Results <p>Immediately after creation of an AVF increased cardiac output, enhanced myocardial contractility and elevation of natriuretic peptides are observed. In the long term, the left ventricular mass increases, the ejection fraction changes and in severe cases hyperdynamic heart failure (HOHF) develops. A&#xa0;Qa &gt; 2 l/min and a&#xa0;Qa to cardiac output ratio ≥ 0.2 are strong predictors of cardiac decompensation. Furthermore, evidence suggests that persistent AVF flow after kidney transplantation can possibly favorably influence graft function and that pre-emptive creation of an AVF in preterminal kidney failure significantly slows the decline of the glomerular filtration rate.</p> Conclusions <p>While the AVF remains indispensable for dialysis, it imposes a&#xa0;substantial burden on both heart and kidneys. An accurate risk stratification integrating hemodynamic parameters, cardiac function and individual comorbidities is essential to balance the benefits and risks of an AVF.</p>

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Herz, Niere, Shunt – eine Dreiecksbeziehung

  • 期刊论文

  • 发表日期：

    2025年10月21日

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  • Richard Kellersmann,
  • David Göppel,
  • Marion Haubitz

摘要

Background

Hemodialysis remains the predominant renal replacement procedure and, in most cases, requires the creation of an arteriovenous fistula (AVF). This nonphysiological connection between the arterial and venous circulations induces relevant hemodynamic alterations. Shortly after creation of an AVF the heart is exposed to an increased volume load, which can result in both acute adaptations and long-term structural changes.

Methods

A systematic review of recent clinical studies and observational data on cardiac and renal effects of an AVF was performed. Imaging modalities (echocardiography, cardiac magnetic resonance imaging, MRI), biomarkers (brain natriuretic peptide, BNP, N‑terminal pro BNP, NT-proBNP) and hemodynamic measurements, including shunt flow (Qa) and its relation to cardiac output were evaluated.

Results

Immediately after creation of an AVF increased cardiac output, enhanced myocardial contractility and elevation of natriuretic peptides are observed. In the long term, the left ventricular mass increases, the ejection fraction changes and in severe cases hyperdynamic heart failure (HOHF) develops. A Qa > 2 l/min and a Qa to cardiac output ratio ≥ 0.2 are strong predictors of cardiac decompensation. Furthermore, evidence suggests that persistent AVF flow after kidney transplantation can possibly favorably influence graft function and that pre-emptive creation of an AVF in preterminal kidney failure significantly slows the decline of the glomerular filtration rate.

Conclusions

While the AVF remains indispensable for dialysis, it imposes a substantial burden on both heart and kidneys. An accurate risk stratification integrating hemodynamic parameters, cardiac function and individual comorbidities is essential to balance the benefits and risks of an AVF.