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Venous Pressure as Predictor of Secondary Arterio Venous Fistula Failure in Patients on Hemodialysis

Background: Autologous arteriovenous fistula (AVF) is gold standard to maintain vascular access for hemodialysis. Actually, creating this type of access is considered very vital for haemodialysis patients. It enables them to avoid serious complication of long use of haemodialysis catheters e.g. local and systemic infections as well as unachieved required dialysis adequacy. Aim of Study: The aim of this study was to assess venous pressure as predictor of secondary arterio venous fistula malfunction in hemodialysis patients clinically. Patients and Methods: This study was designed to assess venous pressure as predictor of secondary arteriovenous fistula malfunction in hemodialysis patients clinically. The study has been conducted on a total of 83 patients with end stage renal disease (ESRD) maintained on regular hemodialysis four hours thrice weekly through AVF. They were dialyzed through a native AVF by Freseinus 4008S Machine, using bicarbonate dialysis solution at the Dialysis Unit at Al-Hussein University Hospital, From Sep. 2020-April 2021. Results: There was statistically significant difference between the two groups ( p -value <0.05) as regard 2 nd and 3 rd D.V.P. There was highly statistically significant difference between 1 st , 2 nd , 3rd D.V.P. measurements in each group ( p-value >0.001) means with different letters significantly differ (Pairwise comparisons between measurements in each group, p <0.05 Significance values have been adjusted by the Bon- ferroni correction for multiple tests). There was no statistical significant difference between the two group ( p -value >0.05) as regard 1 st D.V.P. There was statistically significant difference between the two groups ( p -value <0.05) as regard venous ratio and intra-access pressure (PIA). There was no statistical significant difference between the two group ( p- value >0.05) as regard M.A.P and Normalizes venous pressure. Conclusion: Our study demonstrated that in absence of clinical signs of AVF out-flow stenosis, static and dynamic venous pressure may be used to predict fistula flow in hemodialysis patients. This study demonstrated the feasibility of performing well-designed, randomized, controlled clinical trials in the dialysis population. Further, large, multi-center randomized trials are feasible and will be necessary to confirm the outcome.