Related Experiment Video

Updated: Aug 19, 2026

A Murine Model of Hemodialysis Access-Related Hand Dysfunction
08:39

A Murine Model of Hemodialysis Access-Related Hand Dysfunction

Published on: May 31, 2022

Early detection of arteriovenous fistula problems among pediatric patients on hemodialysis

Ihab Zaki Elhakim1, Tarek A Adel Abd El-Azim2, Walid M Hetta3

  • 1Department of Pediatrics and Pediatric Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Pediatric Nephrology (Berlin, Germany)
|August 18, 2026
PubMed

Insights

Arteriovenous fistula (AVF) dysfunction is common in pediatric hemodialysis (HD) patients. Duplex ultrasonography (DUS) combined with hemodynamic monitoring offers superior early detection of AVF issues compared to physical exams alone.

Area of Science:

  • Pediatric Nephrology
  • Vascular Access Management
  • Biomarker Research

Background:

  • Arteriovenous fistula (AVF) dysfunction is a frequent complication in pediatric patients undergoing maintenance hemodialysis (HD).
  • Early detection of AVF dysfunction is crucial for preserving vascular access in this population.
  • This study investigated multiple diagnostic modalities for identifying AVF dysfunction.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of physical examination, duplex ultrasonography (DUS), intradialytic hemodynamic parameters, and inflammatory biomarkers in detecting AVF dysfunction in pediatric HD patients.
  • To compare the effectiveness of these methods for early identification of AVF complications.

Main Methods:

  • A prospective cohort study involving 59 pediatric patients (age < 18) with stage 5 chronic kidney disease (CKD) on HD via AVF.
  • Serial clinical assessments, laboratory tests (hs-CRP, IL-10, TNF-α), DUS, and intradialytic venous pressure (VP) and transmembrane pressure (TMP) monitoring were performed over 12 months.
  • AVF complications, including thrombosis, aneurysm, and stenosis, were analyzed.

Main Results:

  • AVF complications occurred in 55.9% of patients, with thrombosis, aneurysm, and stenosis being most common.
  • Duplex ultrasonography (DUS) demonstrated higher sensitivity than physical examination for detecting dysfunction.
  • Elevated intradialytic venous pressure (VP) and transmembrane pressure (TMP) were significant early indicators of dysfunction, preceding structural changes seen on DUS.
  • High-sensitivity C-reactive protein (hs-CRP) and IL-10 levels were elevated at complication onset, with hs-CRP showing potential for identifying stenosis.
  • Aneurysms were associated with higher flow and diameter, while thrombosis correlated with reduced diameter and flow.

Conclusions:

  • AVF dysfunction is highly prevalent in pediatric HD patients.
  • Duplex ultrasonography (DUS) is more effective than physical examination for early AVF dysfunction detection.
  • Intradialytic hemodynamic parameters (VP and TMP) serve as valuable early warning signs of impending AVF dysfunction.
  • hs-CRP may aid in identifying stenosis, though other inflammatory markers have limited utility.
  • A multimodal surveillance strategy incorporating clinical evaluation, DUS, and hemodynamic monitoring is recommended to optimize AVF outcomes in pediatric patients.
Abstract

Keywords:
Arteriovenous fistulaDuplex ultrasonographyHemodialysisHs-CRPTransmembrane pressureVenous pressure

More Related Videos

Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique07:30

Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique

Published on: April 1, 2022

Related Concept Videos

Hemodialysis I: Introduction01:25

Hemodialysis I: Introduction

Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
Hemodialysis II: Procedure and Complications01:24

Hemodialysis II: Procedure and Complications

DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...