Uraemic cardiomyopathy, urgent AVF

Ward Consult – 76-year-old man for consideration of urgent Fistula formation 


  • Sarcoidosis
  • Bronchiectasis – previous haemophilus influenzae pneumonia
  • Chronic Kidney Disease – Hypertensive and diabetic nephropathy
  • Nephrectomy – Renal Cell Carcinoma
  • Sarcoidosis


  • Admitted to hospital with dyspnoea and worsening renal function
  • CXR showed fluid overload and cardiomegaly. 
  • Echocardiogram performed – pericardial effusion
  • Pericardiocentesis – 1.2 Litres drained!
  • Significant discussions between treating teams regarding the need for AV Fistula to commence Haemodialysis


  • Cardiology team advocating for a fistula. Concerned regarding uraemic cardiomyopathy as a cause of fluid overload and pericardial effusion
  • Nephrology team of the opinion that uraemia is very unlikely to be the cause. 
  • Additionally, renal function was improving and if dialysis was required then it could be done via VasCath initially
  • Discussion regarding the use of a fistula in the immediate postoperative period. There is often a 6-week delay to allow for maturation of vessels.
  • Timing of fistula use is dependent on the use of native vessels vs Graft. Can be used earlier with graft.


  • Discussion between all teams ultimately concluded that procedure wasn’t required at present