Abstract
Background: Chronic volume overload and high arterio-venous fistula (AVF) flow contribute to CHF in the setting of CKD. An AVF increases cardiac output (CO), which can cause high-output heart failure. Case reports demonstrate reversal of CHF with AVF narrowing. The accepted “cut-off” for high AVF flow is > 2 L/min or > 20-25% of CO, as measured at the AVF. The mechanism of myocardial dysfunction in the setting of high flow and high volume is poorly understood, but may be related to high myocardial sheer wall stress.
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