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High-output heart failure (HOHF) is a less known clinical entity characterized by heart failure signs and symptoms and by high cardiac output indexed to body surface area (cardiac index, CI> 3.9 L/min/m2). In our larger ongoing longitudinal cohort study (CZecking HF/CKD), HOHF was the second most frequent heart failure phenotype (reaching 9% of all patients). Higher arteriovenous dialysis fistula (AVF) flow (Qa) is considered as the etiology of HOHF, but other etiologies were determined in the general population. The aim of this analysis was to describe the frequency of possible etiologies among our HOHF hemodialysis patients, specifically high Qa, anemia, and overhydration.
We selected patients with HOHF (n = 19, that is 9% of all 212 included patients). The frequency of the following HOHF risk factors was recorded: 1. high Qa (≥1500 mL/min), 2. low level of blood hemoglobin (≤10 g/dL) and 3. high dry weight (assessed by both bio-impedance and inferior vena cava diameter/collapsibility).
Selected patients were 61±17 (mean±SD) years old, CI was 4.78±0.67 L/min/m2 and Qa 2101±1242 mL/min. Four patients had no risk factors, 7 patients had 1 or 2 risk factor and one patient 3 risk factors. Only 11 patients had high flow AVF.
This analysis documents multiple etiologies of HOHF among patients on chronic hemodialysis. Future research should be more oriented to this heart failure phenotype.