Cardiac Dysfunction After Arteriovenous Fistula Creation: A Clinical Dilemma in Identifying High-Risk Patients

Heart failure is prevalent among patients with end-stage renal disease (ESRD), particularly those receiving maintenance hemodialysis. Arteriovenous fistulas (AVFs) remain the preferred form of long-term vascular access because of their durability and lower risk of infectious and other complications. Creation of an AVF produces important hemodynamic alterations which may impose additional cardiovascular stress in susceptible patients. Although these adaptations are generally well tolerated, patients with pre-existing cardiovascular disease, limited cardiac reserve, or excessive access flow may develop or experience worsening cardiac dysfunction, including high-output heart failure. This short communication discusses selected evidence concerning the cardiovascular consequences of AVF creation, factors associated with increased hemodynamic burden, and practical considerations for identifying, evaluating, and managing patients at increased risk of AVF-associated cardiac dysfunction. An individualized approach incorporating baseline cardiovascular status, access characteristics, clinical findings, and post-AVF hemodynamic assessment is essential to balance adequate dialysis access against cardiovascular tolerance.