الفهرس 
VASCULAR ACCESS IN HEMODIALYSISOnly 14 pages are availabe for public view
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Abstract
C
hronic renal failure (CRF) is associated with significantly increased morbidity and mortality. chronic renal failure affects almost every system of the body and results in various functional and structural abnormalities.
Long-term hemodialysis (HD) therapy as it is usually prescribed in the United States is inherently burdensome to patients. Conventional HD overwhelmingly involves 3 sessions per week, each 3 to 4 hours in duration.Cumulatively, such time “on the machine” consumes 9 to 12 hours per week.
Life-sustaining haemodialysis (HD) requires durable vascular access (VA) to the circulatory system. The ideal permanent VA must provide longevity of use with minimal complication rate and supply high enough blood flow to deliver the prescribed dialysis dosage.
The success of hemodialysis for patients with end- stage kidney disease deponds on the integrity of the vascular access.Vascular access function is an important determinant of patient mortality, morbidity, and quality of life as such it’s referred to as the”Achilles’ Heel of hemodialysis.
An arteriovenous fistula is currently considered the gold standard access for hemodialysis, as it has lower risk for infection, lower tendency to thrombotic occlusion, greater blood flow, reduced treatment time and is less expensive to maintain than alternative vascular access methodologies.
Cardiovascular complications are the main cause of death in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) therapy accounting for 40% of deaths.
The traditional risk factors for cardiovascular disease do not completely explain this high risk, which seems to be influenced by the so-called nontraditional risk factors associated with CKD. This set of factors accelerates the course of coronary artery disease and is associated with a higher prevalence of ventricular hypertrophy, myocardial fibrosis, valvulopathies, arrhythmias and sudden death.
ESRD is associated with a variety of cardiac alterations including left ventricular hypertrophy (LVH), left ventricular (LV) dilation, and reduction in systolic and diastolic function, with only 16% of new dialysis patients
presenting with normal cardiac morphology and function.
On echocardiography, (15%) had systolic dysfunction,(32%) had LV dilatation and (74%) had LVH.
Patients undergoing chronic HD show an increased prevalence of pulmonary hypertension during treatment (15–20%).
However, although most available studies focused on LV function in dialysis patients, the impact of dialysis treatments on the development of right ventricular dysfunction (RVD) has not been fully investigated.
However, recently study in which investigated the impact of different dialysis treatments on right ventricular (RV) function showed that compared with peritoneal dialysis, hemodialysis increases the risk of RVD particularly in the presence of brachial ateriovenous fistula (AVF).
Patients on hemodialysis have several risk factors for developing PH: LV systolic and diastolic dysfunction, volume overload, endothelial dysfunction and sleep-discorded breathing.However, the presence of an AVF has been shown to be an independent risk factor for the development of PH in ESRD patients.
The aim of this study was to study the prevalence of right ventricular diastolic dysfunction in relation to type of vascular access in chronic hemodialysis patients.
The study was conducted on one hundred (100) patients on hemodialysis thrice weekly for more than 6 months duration through a permanent vascular access.
Our results showed echocardiography parameters distribution of the study group, PHT was (42%),Tricuspid regurge was (49%), RVD was (42%) and RV dilatation was (40%).
Our results also showed significant statistical difference between right ventricular diastolic dysfunction and urea reduction ratio and there was also significant statistical difference between right ventricular dysfunction and types of vascular access.