High-Output Heart Failure: How to Define It, When to Treat It, and How to Treat It

Haimanot Wasse*, M. Salman Singapuri

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Although hemodialysis patients who initiate and maintain a permanent form of dialysis vascular access have improved all-cause and cardiovascular survival compared with those who use catheters, the presence of an arteriovenous fistula has been shown to have a short-term, adverse effect on cardiac function. Through its effect as a left-to-right extracardiac shunt, the arteriovenous fistula can increase cardiac workload substantially, and, in certain patients, result in a high-output state and resultant heart failure over time. Here we review the mechanisms by which dialysis arteriovenous access may promote the development of high-output cardiac failure in end-stage renal disease patients, describe risk factors for and the diagnosis of high-output heart failure, and suggest management strategies for patients who develop high-output heart failure.

Original languageEnglish (US)
Pages (from-to)551-557
Number of pages7
JournalSeminars in nephrology
Issue number6
StatePublished - Nov 1 2012


  • Dialysis access
  • ESRD
  • High-output failure

ASJC Scopus subject areas

  • Nephrology


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