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Forty percent of end stage kidney disease (ESKD) patients have a history of heart failure, and 39% have a history of ischemic disease at baseline [Hemodialysis (HEMO) study]. An arteriovenous (AV) access is the preferred access for dialysis, as it reduces risks of infections and hospitalizations and need for interventions. It is well documented that the creation of AV access can cause or aggravate heart failure (