What question did this study set out to answer?

To investigate the connection between high-flow arteriovenous fistula and muscle cramps in hemodialysis patients.

January 22, 2026Open Access

Dialysis-associated muscle cramps related to high-flow arteriovenous fistula and high cardiac output failure reversed with fistula ligation

IWIhab WahbaPhiladelphia VA Medical Center

Key Points

To investigate the connection between high-flow arteriovenous fistula and muscle cramps in hemodialysis patients.
Reported a case of a patient with high-flow arteriovenous fistula affecting muscle function during dialysis.
Evaluated muscle cramps severity and ultrafiltration efficiency before and after ligation of the fistula.
High-flow arteriovenous fistula led to severe muscle cramps and limited ultrafiltration.
Post-ligation, muscle cramps were completely reversed, improving fluid management.

Abstract

Abstract Muscle cramps are common in patients undergoing hemodialysis, but their pathophysiology is not well understood. The effect of regional blood flow reduction on the neuro-muscular compartment as a result of high-flow arteriovenous fistula (HFAVF) was not previously implicated in dialysis-associated muscle cramps. We report a patient with HFAVF (Blood flow rate 2450 mL/min) causing high cardiac output failure, who developed severe muscle cramps during dialysis, significantly limiting ultrafiltration and causing fluid overload. Ligation of the fistula resulted in complete reversal of muscle cramps, allowing for adequate ultrafiltration. This case highlights the need for clinical vigilance and potential screening for HFAVF in dialysis patients presenting with persistent muscle cramps.

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