Early Detection of Arteriovenous Fistula Problems among Pediatric Hemodialysis Patients

Abstract Background End stage Kidney disease (ESKD) is a major problem that is related to development of inflammation. Establishment of vascular access (VA) in the form of arteriovenous fistula (AVF) is mandatory to conduct efficient hemodialysis (HD). VA complications are one of the main causes of increase in morbidity and mortality in ESKD patients, which needs to be monitored regularly. Objective to evaluate the value of duplex ultrasound (DUS) and inflammatory markers (high sensitivity (hs) CRP, IL10, TNF) in early detection of vascular access complications in pediatric ESKD patients on regular HD. Methods This observational and interventional study was carried on 59 pediatric patients on regular HD at the PediatricDialysis Unit, Children’s Hospital, Ain Shams University, where DUS and serum level of inflammatory markers (hs-CRP, IL10, and TNF) were assessed once at time of enrollment (1) and the second at the time of early clinical suspicion of VA complication (2) which was detected by any abnormalities in physical examination. Results The study comprised 59 pediatric patients on regular HD, their mean (± SD) age was 13.97 (±2.65) years, 39 (56.5%) of them were males. The most common etiology of CKD was congenital anomalies of kidney and urinary track (CAKUT). Complications of the VA were reported in 55.9% of our studied patients, which include thrombosis, aneurysm, stenosis, early VA failure, pseudoaneurysm and perivascular hematoma, where thrombosis was the most frequent (28.8%), and was confirmed by DUS. AVF diameter (2), and flow volume (2) were significantly lower among patients with AVF thrombosis. The mean serum level of hs CRP was significantly elevated at the time of early clinical suspicion of AVF stenosis, and was confirmed by DUS, in comparison to its baseline level at time of enrollment of the study (0.08±0.08, 0.16±0.28 ng/mL, respectively, p = 0.04), serum IL10(1&2) and TNF (2) were higher in this group. Early VA failure were reported in patients who had lower AVF diameter (1), PSV (1), EDV(1&2),flow volume (1&2), and higher AVF diameter (2), PSV (2). Conclusion DUS and hs-CRP are useful tools for early detection and, hence the management of AVF complications.