Transplantation or dialysis for patients who have end stage renal disease with heart failure

Heart failure (HF) occurs in more than one third of patients with end stage renal disease (ESRD) at the initiation of dialysis. Heart failure alone is an independent predictor of poor outcomes for patients with ESRD. Historically, most transplant physicians and surgeons have considered patients who have ESRD with HF as exceedingly high risk for transplantation. However, recent data show that renal transplantation in patients who have ESRD with nonischemic HF results in an improvement in ventricular function and survival benefit when compared to staying on dialysis. The purpose of this article is to review outcomes of both dialysis and renal transplantation for patients with ESRD and HF as well as to present an algorithm for their management.