BARUCH J. HURWICH, M.D.
To the editor: I wish to question the validity of Dr. Ronald A. Draur's conclusion that three dialysis patients' arteriovenous fistulas caused heart failure (Ann Intern Med 79:765, 1973). His table suggests that closure of the fistulas resulted in a decrease of blood flow of 11000, 1100, and 1960 ml/min through the affected limb, as the differences in cardiac output imply indirect measurements of flow through the fistula.
Since several studies corroborated my findings (1), by plethysmographic methods, that mean flow through a radial arteriovenous fistula is about 220 ml/min, Dr. Draur's results, especially the first figure, seem excessive. In
HURWICH BJ. Dialysis Fistula and Heart Failure. Ann Intern Med. 1974;80:561–562. doi: 10.7326/0003-4819-80-4-561
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Published: Ann Intern Med. 1974;80(4):561-562.
Cardiology, Heart Failure, Nephrology, Renal Replacement Therapy.
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