Summary
Introduction. The population of patients with end-stage renal disease (ESRD) is rapidly growing. Due to the lack of kidney donors and low penetration of peritoneal dialysis, hemodialysis (HD) remains the most common treatment option. The formation of arteriovenous fistula (AVF) is considered as a priority vascular access for HD patients in clinical practice. However, many complications are associated with this access, also including high-output heart failure which increase death rate and provoke challenges to doctors.
Case report. We describe a 42-year-old man with end-stage renal disease, IgA nephropathy, secondary anemia, tubulointerstitial nephritis, secondary hyperparathyroidism and atrial fibrillation. The patient was successfully managed and the AVF closure surgery due to the aneurysmatic changes was performed while a new fistula was constructed in the opposite arm.
Conclusions. In order to prevent the development of high-output heart failure in a population of HD patients, symptomatic treatment remains the gold standard for ensuring adequate vascular access to dialysis. Failing to reconcile these two goals, AVF should be closed by surgical procedure and alternative vascular access should be made.
