الفهرس 
Epidemiology and Pathophysiology of chronic Kidney Disease
Epidemiology of End-Stage Renal DiseaseOnly 14 pages are availabe for public view
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Abstract
End-stage renal disease (ESRD) patients often require either the formation of an arteriovenous (A-V) fistula or graft for haemodialysis. These access sites should ideally have a long life and a low rate of complications (for example thrombosis, infection, stenosis, aneurysm formation and distal limb ischaemia).
Thrombosis of hemodialysis vascular access grafts represents a major medical and economic burden.
Dyslipidemia are usually present in chronic renal disease and end stage renal failure is generally associated with hypertriglyceridemia.
Omega-3 fatty acids play an important modulatory role in the immune and inflammatory responses, the progression of arteriosclerosis, vascular reactivity and BP control, cell membrane function, and gene expression.
Fish oils have been demonstrated to have anti-platelet effects, and reduce intimal hyperplasia in autogenous grafts. In addition, reductions in neointimal hyperplasia formation and enhanced endothelial function have been reported. Such effects may improve AVF and AVG patency by addressing the problem of both thrombosis and stenosis and enhanced endothelial function may also contribute to improved AVF maturation.
Our study was designed to evaluate the role of ω-3 fatty acids in preserving the patency of arteriovascular fistulas and grafts in hemodialysis patients.
The study was a prospective randomized case control study conducted on 80 chronic hemodialysis patients who currently undergoing hemodialysis three sessions per week for more than 3 months in our hospital (El Maadi Liver & kidney transplantation hospital). The study was conducted through a period of time spanning 6 months.
They were divided into two groups;
group 1: (40 hemodialysis patients receiving ω-3 fatty acids for 6 months)
group 2: (40 hemodialysis patients not receiving ω-3 fatty acids).
Our study was conducted on 80 chronic hemodialysis patients 40 of them were females (50%), 40 of them were males (50%) (table 1).
In our study atrophic kidneys was the most common aetiology of end stage renal disease in group 1 and polycystic kidney disease was the most common aetiology of end stage renal disease in group 2 (table 6).
AVF was the vascular access in 82.50 % of patients versus 17.50 %, having AVG (table 4).
In our study there was highly significant statistical decrease in triglyceride level in group 1 compared to group 2 over the six months period (p<0.001) (table 10) (figure 36).
In our study there was highly significant statistical decrease in total cholesterol level in group 1 compared to group 2 over the six months period (p<0.001) (table 10) (figure 37).
Similarly there was highly significant statistical decrease in LDL level in group 1 compared to group 2 over the six months period (p<0.001) (table 10) (figure 38).
In our study there was highly significant statistical increase in HDL level in group 1 compared to group 2 over the six months period (p<0.001) (table 10) (figure 39).
In our study there was no significant statistical difference between the two groups as regard hemoglobin level,calcium and phosphorus level over the six months period (p<0.05) (table 10) (figure 42, 43, 44).
In our study there was significant statistical increase in PTH in group 2 compared to group 1 over the six months (p<0.05) (table 10) (figure 45).
In our study there was increase in blood flow in group 1 more than in group 2 but not reaching a statistically significant difference (table 10) (figure 40).
In our study there was highly significant statistical decrease in blood flow in 1st, 2nd, 3rd, 4th, 5th and 6th month in comparison to Basal in both two groups (p<0.001) (table 7.8)
In our study there was highly significant statistical increase in URR in group 1 compared to group 2 over the six months period (p<0.001) (table 10) (figure 41).
Examination and auscultation of arteriovenous fistulas and grafts done to all patients in every hemodialysis session during the six months.
Simple clinical signs such as prolonged bleeding after canula withdrawal and a change in the bruit over the access by auscultation were observed in all eight patients.
Angiography can identify any stenotic lesions within the dialysis access.
In our study Angiography was done to eight patients (10%) (p = 0.456), three of them in group 1 (7.5%) and the remaining five were in group 2 (12.5%) (table 5).
The three patients in group 1 all were females and they had radiocephalic AVF, AVG and brachiocephalic AVF as a vascular access .The five patients in group 2, four of them were female and they had radiocephalic AVF as a vascular access, the remaining one had brachiocephalic AVF as a vascular access and he is a heavy smoker. And this result agrees with the study done by Rittgers et al., 1986 which showed that the rate of blood flow through a hemodialysis fistula or graft is dependent on the location and specific type of vascular access. Fistulas that are created using the radial artery (3 mm) near the hand have slower rates of blood flow compared to those that are created using the brachial artery (6 mm) near the elbow.
20% of the lumen was found stenosed by angiography in all three patients in group 1, while 30% of the lumen was found stenosed in all five patients in group 2.
At present, the data in dialysis patients most strongly supports the use of omega-3 supplementation for the treatment of hypertriglyceridemia and to improve dialysis access patency rates.