Arteriovenous Fistula‐Associated Ascites

Dialysis-associated ascites (DAA) is a diagnosis of exclusion in end-stage kidney disease (ESKD). The prognosis is grim and typically obviates kidney transplantation. We report a case initially misdiagnosed as DAA, which was later correctly identified as cardiac ascites due to high-output heart failure (HOHF) resulting from an aneurysmal arteriovenous fistula (AVF). We propose the term "AVF-associated ascites" (AFAA) to describe this entity. The HOHF improved with AVF ligation with complete resolution of the ascites, thus making the patient eligible to receive a kidney transplant. This case emphasizes the importance of recognizing potential adverse cardiac outcomes in the setting of a large or aneurysmal AV fistula and to appreciate AFAA as an alternate diagnosis to DAA in the hemodialysis patient with ascites.