الفهرس 
End stage renal disease (renal failureOnly 14 pages are availabe for public view
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Abstract
It is still controversial to close or preserve a functioning arteriovenous fistula after successful kidney transplantation (KTx). There are arguments for both options—a patent dialysis fistula, especially hyperkinetic, increases cardiac output and pulmonary pressure, increasing cardiovascular risk, and fistula closure leads to a clinically significant reduction in left ventricle mass and could potentially prevent cardiological complications.
On the other hand, the risk of kidney transplant failure and return to dialysis due to end-stage graft insufficiency, despite continuous progress, is still significant. It is sometimes extremely difficult and not always feasible to obtain a well-functioning dialysis fistula in patients returning to hemodialysis due to kidney transplant failure.
Additionally, the effect of dialysis fistula closure on transplanted kidney function has not been definitively determined; in some studies, it led to the deterioration of renal function, but in others, it led to improved urine volume, renal creatinine clearance and proteinuria.
In patients after kidney transplantation, in addition to ligation or fistula preservation and observation, it is also possible to perform a dialysis fistula reconstruction. A significant percentage of dialysis fistulas in patients after kidney transplantation develop various complications, e.g., stenosis, aneurysms and thrombosis.
Based on this debate, the current study was conducted to detect the effect of closure of dialysis arteriovenous fistula after kidney transplantation on blood pressure, proteinuria, and graft function.
This study was conducted at the nephrology department and follow up of renal transplant unit at Menoufia University Hospitals, Menoufia, Egypt.
The study included 126 kidney transplant recipients who were distributed into two groups according to the patency of arteriovenous fistula; group A (that included 63 Kidney transplant patients with closed arteriovenous fistula) and group B (that included 63 kidney transplant patients with functioning arteriovenous fistula).
After obtaining of a written informed consent from all the participants and approval of the local research committee, Menoufia faculty of medicine, the included cases were subjected to the following; history taking (including the demographic data and history of transplantation and real affection) and clinical examination (with concentration on the blood pressure measurement).
Laboratory investigations were done including assessment of complete blood count, renal function tests, liver function tests and inflammatory blood markers.
The doppler studies were conducted on the arteriovenous fistula and the renal graft. Transthoracic echocardiography was conducted for all the included cases to assess the state of the heart.
The present study showed that:
• The mean age of the cases was 41 years with range between 17 and 75 years and males represented 69.8% of the included cases
• Among the included cases, there were 37.3% smokers.
• Regarding the comorbidities, there was 10.32% with HCV, 65.1% with hypertension and 28.6% with IHD.
• The etiology of Renal Failure among patients included in our study being highest percentage for patients of unknown etiology (32.54%), hypertensive nephrosclerosis (25.4%) and chronic glomerulonephritis (16.67%).
• There was no significant statistical difference between the two groups regard age, sex, BMI, BP, and duration on renal transplantation.
• There is no significant statistical difference between the two groups as regard uric acid, s. albumin., total bilirubin, and RBS.
• There is significant statistical difference between the two groups as regard ALT and AST.
• There is no significant statistical difference between the two groups as regard CBC parameters.
• There is no significant statistical difference between the two groups as regard renal function and proteinuria.
• There is no significant statistical difference between the two groups as regard radiological findings including Ejection Fraction fractional Shortening, graft resistive index in graft doppler and flow in AVF by doppler of arteriovenous fistula.
• There is no significant correlation between 24 hour proteinuria and age, BMI, MBP, Ejection Fraction fractional Shortening, graft resistive index, serum creatinine, and duration of transplantation while there is significant correlation between proteinuria and AVF flow.
• There is no significant correlation between proteinuria and HTN, HCV,IHD,AVF, type of CNI, and type of antiproliferative drug used in patients included in the current study.
• There is no significant statistical difference between the two groups as regard smoking, hypertension and HCV positivity in patients included in the current study.