Surveillance and monitoring of early failing arteriovenous fistula using Doppler assessment in children on regular hemodialysis

Abstract

Abstract Background A well-functioning vascular access is a mainstay to perform an efficient hemodialysis procedure. Limited lifespan of arteriovenous accesses is one of the major challenges of the current long-term hemodialysis therapy. Vascular access-related morbidity accounts for up to 50% of total dialysis patient’s costs. The pediatric vascular access clinical guidelines published by the National Kidney Foundation Kidney Disease Outcome Quality Initiative recommend establishing a surveillance strategy to detect access stenosis and direct patients for early intervention. The aim of this study was to test the role of using the color Doppler ultrasonography (CDU) as a surveillance method for arteriovenous fistulae in children on regular hemodialysis and its value for detecting the early vascular access failure or dysfunction to avoid access loss. Results During 10-month duration, we prospectively conducted surveillance for 30 patients on regular hemodialysis through arteriovenous fistulae (AVF) as a vascular access, clinical assessment of AVF and radiological examination using CDU of the upper limbs. Their ages were ranging from 2 to 18 years with 1:1 male: female ratio. Doppler indices were measured in the afferent arteries, at the site of anastomosis, and the draining veins. AVF stenosis was the highest among all the detected complications (n = 9, 30%), aneurysm and pseudoaneurysmal formation (n = 8, 26%) anastomoses diameter reduction in 16.6%, and it was correlated with the dialysis adequacy measured through the Kt/v. Other complications were thrombosis (n = 2, 6.7%), central venous stenosis (n = 2, 6.7%), steal syndrome (n = 1, 3.3%) and calcifications in (n = 1, 3.3%). In total, 26% of the patients have more than one malfunction. Only one case has access failure a month after CDU examination. Conclusion In conclusion, among pediatric patients CDU can detect early stenosis of AVF in children, which can affect the dialysis adequacy.