Early detection of arteriovenous fistula problems among pediatric patients on hemodialysis

Abstract

BACKGROUND: Arteriovenous fistula (AVF) dysfunction is a common complication in pediatric patients on hemodialysis (HD). Early detection using clinical, radiological, and biochemical markers is essential to preserve vascular access. This study evaluated the diagnostic value of physical examination, duplex ultrasonography (DUS), intradialytic hemodynamic parameters, and inflammatory biomarkers in detecting AVF dysfunction. METHODS: This prospective cohort study included 59 pediatric patients (< 18 years) with chronic kidney disease (CKD) stage 5 on maintenance HD via functioning AVF, followed for 12 months. Patients underwent serial clinical assessment, laboratory testing (hs-CRP, IL-10, TNF-α), and DUS evaluation. Intradialytic venous pressure (VP) and transmembrane pressure (TMP) were recorded, and AVF complications were analyzed. RESULTS: AVF complications occurred in 55.9% of patients, most commonly thrombosis (28.8%), aneurysm (23.7%), and stenosis (10.2%). Physical examination showed moderate sensitivity (66.7%), but high specificity (100%) compared with DUS. Elevated VP and TMP were early indicators of dysfunction, significantly increased prior to structural changes on DUS (p < 0.001). The hs-CRP and IL-10 increased significantly at complication onset and were specifically elevated in stenosis, while TNF-α showed only a non-significant trend. Aneurysm was linked to higher flow volume and diameter, whereas thrombosis was linked to reduced diameter and flow. CONCLUSIONS: AVF dysfunction is frequent in pediatric HD patients. DUS is superior to physical examination for early detection. Intradialytic VP and TMP are useful early markers of impending dysfunction. hs-CRP showed a potential value in identifying stenosis, while other inflammatory markers show limited utility. A combined surveillance approach using clinical assessment, DUS, and hemodynamic monitoring is recommended to improve AVF outcomes.