الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
End-stage renal disease (ESRD) is a major public health problem worldwide, the prevalence of ESRD continues to increase in most countries. In Egypt the prevalence of ESRD is 483 per million population, Hypertension is the leading cause of ESRD in Egypt. Hemodialysis is the most commonly used treatment modality worldwide, hemodialysis patients are receiving treatment through vascular access with native AVF represents the most commonly used access type.
Hemodialysis vascular access dysfunction is a major cause of morbidity and mortality in hemodialysis patients, with stenosis presenting the most common cause of this dysfunction. Stenosis reduces AVF flow and alters the pressure profiles and ends with AVF thrombosis. A multidisciplinary approach to hemodialysis access was applied for monitoring and surveillance of vascular access to assess AVF functionality and early detection of stenosis.
Monitoring strategies include; physical examination (inspection, palpation, and auscultation), and routine laboratory studies regularly obtained in the dialysis unit to calculate dialysis adequacy (urea reduction ratio or Kt/V). Surveillance strategies necessitate periodic assessment of the vascular access by frequent blood flow measurement using CDS and pressure surveillance using VAPR. These currently used flow and pressure dependent tests have limitation for accurate AVF assessment as flow based tests only useful in inflow stenosis while pressure based tests useful in outflow stenosis, so new diagnostic endpoints depend on pressure and flow measurements and fluid dynamics known as resistance index (R) and pressure DROP coefficient (Cp) are new promising methods for better assessment of AVF functionality.
The aim of the current study was to compare the efficacy of both resistance index and pressure DROP coefficient and the current surveillance methods in early detection of arteriovenous fistula failure.
The study included 60 CKD-5D patients undergoing maintenance hemodialysis in Medical Research Institute dialysis units through native AVFs, with mean age 25-66 years old from both sex, and with mean duration of AVF 10 years. All patients were subjected to detailed history, physical examination of AVF (inspection, palpation, auscultation), routine laboratory investigation to calculate Kt/V, AVFs blood flow measurement using CDS, VAPR and the new diagnostic end points (CP) and (R) were measured and compared to the currently used methods.
The results of this study showed that:
• The prevalence of AVF dysfunction is 47% in our patients.
• Outflow obstruction was the only type found in our patients.
• Cp has the potential to diagnose AVF outflow obstruction.
• Cp was significantly higher in patients with AVFs outflow obstruction than normal AVFs.
•The average cut of value for Cp to detect AVF dysfunction was 1.08.
•There was no statistical difference in R between both groups.