Children undergoing chronic hemodialysis are exposed to persistent oxidative stress and systemic inflammation, contributing to long-term cardiovascular complications. Melatonin (MLT) is a pleiotropic hormone with potential antioxidant and anti-inflammatory effects. Due to scarcity of studies on pediatrics this study sought to investigate the effects of MLT on oxidative stress and inflammation in pediatric hemodialysis patients. This prospective, block-randomized, double-blinded, placebo-controlled study aimed at assessing the effect of 5 mg MLT on oxidative stress and inflammation in pediatric hemodialysis patients. Forty eligible patients were randomly allocated into either MLT or placebo group. Serum malondialdehyde (MDA), nuclear factor kappa B (NF-κB) levels and lipid profile were measured at baseline and at the end of the study after 12 weeks. MLT significantly reduced the median percent change of serum NF-κB - 5.404(- 58.25-129.7) with p-value = 0.027 in addition to reduction in median total cholesterol in the MLT group from 163.7(134.5-259.5) at baseline to 144(113-242) at the end of the study with p-value = 0.038 and reduction of low-density lipoprotein levels from 96(78-183) to 78.5(48-171) at the end of the 12 weeks with p-value = 0.002 while there was no significance in the placebo group. Although, there was no statistical significance in serum MDA levels in the MLT group but significant increase in MDA levels in the placebo group was detected. MDA levels increased from 11.79 ± 5.078 to 14.79 ± 4.257 at the end of the study in the placebo group with p-value = 0.048, supplementation appears to have beneficial effects on ameliorating inflammation and reducing serum lipids. Moreover, MLT may have a protective antioxidant effect by reduction and inhibition of elevation of serum MDA levels.Trial registration: The study was registered on ClinicalTrials.gov (identifier: NCT05570526 https://clinicaltrials.gov/study/NCT05570526), on 6th of October 2022.

In pediatric hemodialysis patients with exhausted vascular access, managing rare pathogens like Ochrobactrum intermedium is challenging, often posing a dilemma between catheter removal and salvage attempts. There are few reports on the supported viability of meropenem-heparin lock therapy for this purpose in pediatric patients. We present the case of a 12-year-old male with chronic kidney disease on hemodialysis who was admitted with sepsis attributed to her long-term hemodialysis catheter. Ochrobactrum intermedium was isolated from all catheter lumens and blood cultures. Due to a documented history of vascular access failure, catheter salvage was the primary goal. A combined systemic antibiotic and lock therapy with meropenem and unfractionated heparin was initiated. Critically, bacteremia relapsed promptly after a planned temporary suspension of the lock therapy, while systemic antibiotics were continued. Definitive microbiological eradication was only achieved after the re-initiation and completion of a 14-day course of the lock therapy, resulting in full clinical recovery and long-term catheter preservation. This case report suggests the potential efficacy of meropenem lock therapy as a salvage strategy for O. intermedium CRBSI when catheter removal is not a viable option. The relapse upon its suspension highlights that the lock therapy itself was the critical component for eradicating the O. intermedium biofilm, a feat the systemic antibiotic alone could not achieve. This approach is a viable alternative when catheter removal is not feasible.

The choice of vascular access (VA) plays a key role in the success of hemodialysis (HD). Despite their widespread use, central venous catheters (CVCs) are associated with higher rates of dysfunction, thrombosis, and catheter-related bloodstream infections (CRBSI). We investigated current practices in pediatric HD across European pediatric nephrology centers, focusing on VA choices, infection control measures, and CRBSI management. An online questionnaire was e-mailed to 119 members of the European Society for Pediatric Nephrology (ESPN) Dialysis Working Group and European Pediatric Dialysis Working Group (EPDWG). Descriptive statistics were used to summarize practices across centers, comparative analyses between centers in countries with Human Development Index (HDI) > 0.90 and < 0.90. Thirty-one centers across Europe participated in the survey. CVCs were the primary VA in 73.1% of the centers. Twenty (66.7%) centers reported malfunction as the most common CVC complication, followed by catheter thrombosis (19.4%) and CRBSI (12.9%). The diagnostic approach for CRBSI varied widely, with 35.4% of centers relying on a single positive catheter culture, while 57.9% did not collect a second culture from the peripheral vein or HD circuit. The most common empirical treatment was glycopeptides combined with third-generation cephalosporins. Nearly all centers used intravenous antibiotics for less than 3 weeks, and over half modified lock solutions with antibiotics following CRBSI diagnosis. Catheter removal practices were inconsistent, even in cases of severe infection. Centers reported a total of 548 HD patients. Exit-site infections and CRBSI were observed in 98 (17.8%) and 155 (28.2%) patients, respectively. CRBSI rates and CRBSI-related catheter replacements were significantly higher in centers from countries with HDI < 0.90 and in centers without a dedicated pediatric HD unit.Conclusion: The suboptimal adherence to current VA recommendations and wide variability in catheter care practices including the prevention, diagnosis, and management of CRBSI highlight the need for standardized pediatric-specific protocols to enhance catheter longevity and improve patient outcomes.What is Known:• Central venous catheters are widely used in pediatric hemodialysis but carry a high risk of complications, especially catheter-related bloodstream infections (CRBSI).What is New:• This multinational survey reveals significant variability in vascular access selection, CRBSI prevention, diagnosis, and treatment across European pediatric hemodialysis centers, with clear disparities by national HDI levels.• The findings highlight the need for standardization of vascular access care and CRBSI management and evidence-based pediatric-specific guidelines.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00431-025-06703-7.

Background: The arteriovenous fistula is recognized as the ideal and most commonly utilized technique of vascular access for hemodialysis, typically regarded as the optimum standard in clinical practice. Instructional programs are imperative for equipping nurses with the required skills to enhance patient outcomes and decrease overall health care expenses. Objectives: The aim of the study was to evaluate the effect of instructional guidelines on nurses' performance regarding care of arteriovenous fistula puncture for hemodialysis children. Methods: The study design was quasi-experimental. At Beni-Suef University Hospital's pediatric hemodialysis unit, the study was carried out. A purposive sample composed of 50 nurses. Data were gathered utilizing two tools: The 1st tool is the interviewing questionnaire sheet. The 2nd tool is observational checklists. Results: More than three-quarters of nurses had an unsatisfactory total level of knowledge, and the majority of them had an incompetent total level of practice regarding arteriovenous fistula puncture care in the pre-instructional guidelines implementation. While most of the nurses had a satisfactory total level of knowledge, four-fifths of them had a competent total level of practice in the post-instructional guidelines' implementation with a highly statistically significant difference (p-value &lt; 0.000). Also, there was a highly statistically significant positive correlation between nurses' total knowledge and total practice level pre- and post-implementation. Conclusion: The study findings confirmed the effectiveness of the instructional guidelines in improving nurses' knowledge and practices concerning arteriovenous fistula puncture care for hemodialysis children. Recommendation: Implementing periodical instructional programs for nurses concerning arteriovenous fistula puncture care is necessary to update and improve their performance.

Catheter-related bloodstream infections (CBSI) are serious complications in pediatric hemodialysis (HD) patients. We aimed to compare the CBSI rates associated with cuffed and uncuffed central venous catheters (CVC) in small children. All HD patients weighing <15kg and dialyzed via cuffed CVCs for at least 3 months between March 2016 and March 2022 were included. The CBSI rate was compared to that of a well-matched historical series of our patients before implementing cuffed CVCs. Three boys and 1 girl (median weight: 14.0kg) matched the inclusion criteria and received HD using the same type of cuffed CVC. Eleven CBSIs occurred during 4,870 days with cuffed CVCs, yielding a CBSI rate of 2.3/1,000 catheter days, compared to 7.7/1,000 catheter days in our historical series with uncuffed CVCs (p=0.002). A 70% reduction in the CBSI rate was achieved with cuffed CVCs (p=0.002). The median catheter survival times for cuffed and uncuffed CVCs were 189 and 53 days, respectively (p=0.002). Our results show that cuffed CVCs are associated with reduced CBSI rates and improved catheter longevity compared to uncuffed ones in small children.

Hemodialysis (HD) is a method of kidney replacement therapy designed to remove uremic toxins from the body. Beta-2 microglobulin (beta-2 MG) is a middle molecule not yet effectively removed by conventional low-flux dialysis membranes and may contribute to long-term complications in chronic HD patients. While well-studied in adults, data in pediatric populations are limited. This study evaluated beta-2 MG levels before and after HD in children and assessed associations with dialysis prescription parameters and cardiovascular comorbidities. A cross-sectional study was conducted from June to July 2024 at the Kiara Children's Dialysis Unit, Rumah Sakit Umum Pusat Nasional (RSUPN) Cipto Mangunkusumo, Indonesia. Pre- and post-HD beta-2 MG levels were measured. Dialysis prescriptions, laboratory values, and cardiovascular parameters were recorded and analyzed for correlations with beta-2 MG levels and reduction ratios. The study involved 38 subjects, of whom 22 (57.9%) were male, with an average age of 13.2 ± 2.9years. Most patients received HD twice weekly. Pre-HD beta-2 MG levels were elevated in all patients. Synthetic-based high-flux dialyzers were significantly associated with greater beta-2 MG reduction ratios compared to cellulose-based low-flux membranes (r = 0.716; p = 0.000). No significant correlations were found between beta-2 MG levels and other HD parameters, laboratory markers, or cardiovascular outcomes. Synthetic-based high-flux dialyzers were associated with improved beta-2 MG clearance in pediatric HD patients, though pre-HD levels were comparable across membrane types. Further longitudinal studies are warranted to determine the clinical significance of beta-2 MG reduction and guide dialysis optimization in children.

Abstract With the rapid development of artificial intelligence (AI) and machine learning (ML), the medical field is experiencing significant advances that make it easier for doctors to monitor and personalize the hemodialysis process in pediatric patients. This case study focuses on the prediction of hydration in pediatric hemodialysis using hybrid ML models with hyperparameters for prediction accuracy. Data were collected from pediatric hemodialysis at the University Children's Hospital in Tiršova, and parameters such as weight, blood pressure, lean tissue index (LTI), fat tissue index (FTI), body mass index (BMI), total body water, extracellular water (ECW), adipose tissue mass, body cell mass, and bioimpedance were adjusted for training. The model was configured for each pediatric patient and retrained after each treatment to make individualized predictions with the highest accuracy. The proposed model uses measurable parameters to estimate hydration and provide better recommendations to the physician, leading to better results than commonly used state-of-the-art competing methods. The hybrid ML models with hyperparameters represent a novel, simplified, safe, and efficient method for predicting hydration in children, making it easier for doctors to monitor the hemodialysis process for children.

Pediatric hemodialysis is a life-saving treatment for children with chronic kidney diseases. Central venous catheters (CVCs) are the most commonly used vascular access, despite being commonly subject to complications leading to inadequate hemodialysis and catheter replacement. The available CVCs feature various design elements reflecting ongoing efforts to achieve optimal performance. Computational fluid dynamics (CFD) can contribute to analyze the flow dynamics within the CVCs. The aim of this study is to investigate the design parameters that most influence the flow performance of CVCs. A design of experiment (DOE) was set up to assess the CFD of two CVC models of 6.5F and 8F size. Blood flow rates, shear stress, residence time, and platelet lysis index were evaluated. The results showed how the proximal side holes were the most influential geometrical features, influencing both the flow rates (r > 0.64) and the shear stress of the CVCs (|r| > 0.5). At increased flow rate, the side holes were found to be competing with the tip in terms, especially, of residence time inside the CVC. The findings of this DOE show how CFD can contribute to understand the influence of design parameters and potentially guide the development of optimized pediatric-specific CVC models.

Introduction-Aim: Children with kidney failure (KF) are prompt to undernutrition with subsequent growth failure. The aim of this study was to assess probable correlates of normalized protein catabolic rate (nPCR) in children on chronic hemodialysis (HD). Methods: This prospective study included all 20-year-old or less patients undergoing chronic HD at our pediatric HD unit between 1st January 2024 and 30th April 2024. Patients included had been on HD for more than 3 months and were clinically stable. For each patient, baseline characteristics were recorded along with their echocardiogram findings. Mean nPCR was calculated and potential predictive factors were simultaneously evaluated. Our study included a univariate and a multivariate analysis. A p value less than 0.05 was considered statistically significant. Results: A total of 40 patients were included with a mean age of 14.4 ± 3.7 years old and a sex-ratio M/F of 1.9. Twenty-two (55%) had a mean nPCR &lt;1g/kg/day. A strong positive correlation between nPCR and the 3-months body mass index variation percentage was found with a correlation ratio of 0.82. On multivariate analysis, Patients with a single pool KT/V &lt; 1.2 and those exhibiting left ventricular hypertrophy were more likely to have a nPCR value &lt;1g/kg/day (OR: 7.2 and 11.1, 95% CI: 2.28 – 75.23 and 5.5-98,08, respectively). A first hour refill index &gt; 1.7 ml/kg/h/% was also correlated with a low nPCR (Adjusted OR:5.5- 95% CI: 3.2-65.2). Conclusion: Pressure and volume control along with dialysis adequacy are promising factors in improving....(abstract truncated at 250 words).

Background: Catheter-related bloodstream infections (CRBSIs) remain a major contributor to morbidity in children receiving chronic hemodialysis, particularly in Latin American settings where surveillance data are scarce and fragmented. This study provides a comprehensive analysis of CRBSI incidence, microbiological profiles, and clinical outcomes at a national pediatric referral center in Mexico. Methods: A retrospective study including pediatric patients (&lt;18 years) who underwent hemodialysis via central venous catheters (CVCs) from January 2016 to May 2024 was carried out at the Hospital Infantil de Me xico Federico Go mez. Based on CDC diagnostic criteria, confirmed CRBSI episodes were identified. Using descriptive statistics, demographic characteristics, microbiological results, therapeutic regimens, and clinical outcomes were methodically examined. Results: Among 56 pediatric patients, a total of 89 catheter-related bloodstream infection (CRBSI) episodes were identified, resulting in an incidence of 11.6 episodes per 1,000 catheter-days. Staphylococcus aureus (39.3%), Staphylococcus epidermidis (23.6%), Klebsiella pneumoniae (9.0%), and Enterococcus faecalis (4.5%) were the most frequently isolated pathogens. The most affected groups were school-age children (37.1%) and adolescents (40.4%). The most used empirical regimen was vancomycin plus cefepime (58.4%). Catheter removal was required in 36% of episodes. No infection-related deaths were recorded. A substantial decrease in CRBSI incidence was observed from 2021 onwards. Conclusion: The substantial decline in infection rates underscores the effectiveness of targeted preventive strategies, including standardized catheter care protocols, continuous microbiological surveillance, and context-specific therapeutic interventions. These measures have demonstrated a meaningful impact in safeguarding pediatric hemodialysis patients, a population inherently vulnerable to catheter-related complications.

Pediatric patients undergoing hemodialysis (HD) frequently suffer considerable pain and anxiety during vascular access steps. Non-pharmacological tools, such as virtual reality (VR), have been illuminated as promising approaches to alleviate these negative experiences. This review presents recent research advances in understanding the power of VR in lowering pain and anxiety in pediatric HD patients. VR, a technology that immerses users in simulated environments, has been shown to successfully distract patients from painful procedures, thereby reducing pain perception and anxiety levels. Research have revealed that VR can obviously decrease pain intensity, anxiety, and better patient satisfaction during vascular access procedures. By providing immersive experiences, VR can redirect attention away from the painful stimulus, modifying the physiological and psychological reactions correlated with pain and anxiety. As VR technology remains to advance, its integration into pediatric HD care has the eventual to pointedly meliorate the quality of life for young patients submit to these procedures.

BackgroundThe application of international recommendations for paediatric maintenance haemodialysis (HD) could be strengthened by national laws or written recommendations. Our aim was therefore to describe the national rules governing paediatric maintenance HD in European countries.MethodsA national representative, approved by the president of each paediatric nephrology society, was contacted in all 42 European countries to complete two online questionnaires.ResultsAnswers were received from 36 countries. The population served by HD centres varies from 83,000 to 1,197,000 residents below 18 years of age and the estimated mean number of children on HD per centre from 0.2 to 13.5. The lowest age at which a child can be dialysed in an adult centre varies from 0 to 18 years. Laws or written national recommendations specifying: this age, the need for a paediatrician as part of medical team in mixed adult–paediatric centres, the minimum number of doctors per centre and the number of patients per nurse or nurse’s aide required during sessions exist in only 25, 22, 22, 44 and 8% of the countries, respectively. Similarly, dietitians, social workers, school service, psychologists and play specialists/youth workers are required by law or written national recommendations in 36, 28, 36, 31 and 14% of countries, respectively.ConclusionLaws or written national recommendations for paediatric maintenance HD are rare in European countries and very heterogeneous when they exist. This calls for discussion among paediatric and adult nephrologists and health authorities on the organisation of safe and effective paediatric HD practices.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

BackgroundThere is evidence from clinical trials that coenzyme Q10 significantly improves mitochondrial function and decreases oxidative stress and cardiovascular disease in adult hemodialysis patients. However, we have never fully investigated its role in pediatric patients before. This study aimed to assess the effects of coenzyme Q10 supplementation on oxidative stress and inflammatory markers in pediatric hemodialysis patients. This was a prospective, randomized, double-blinded, placebo-controlled trial. Thirty-six pediatric hemodialysis patients were recruited and simply randomized to receive either oral coenzyme Q10 (3–5 mg/kg) daily or placebo daily for 12 weeks.ResultsUsing the Mann–Whitney test, children in the intervention group showed a significant reduction in the median percent change of blood urea nitrogen from baseline of − 58.18 versus − 9.6 in the placebo group (p = 0.002). The median percent change of serum malondialdehyde significantly decreased by − 55.68 in the intervention group, while it increased by 39.75 in the placebo group (p < 0.001). Additionally, the median percent change from baseline in serum tumor necrosis factor-α levels significantly decreased by − 46.69 in the intervention group and increased by 8.5 in the placebo group (p = 0.03).ConclusionSupplementation of oral coenzyme Q10 may have beneficial effects on oxidative stress and inflammatory markers in pediatric hemodialysis patients. This study emphasized the potential efficacy of an average coenzyme Q10 dose of 4 mg/kg/day in pediatric hemodialysis patients; this gives the green light for other researchers to confidently evaluate larger doses as an attempt to control the systemic inflammation in this patient population. Further research is needed to determine whether coenzyme Q10 treatment improves clinical outcomes such as infection, hospitalization, cardiovascular events, and mortality in pediatric hemodialysis patients.Trial Registration Clinical trials.gov, NCT05170893, Registered 28 December 2021, https://clinicaltrials.gov/study/NCT05170893?cond=NCT05170893&rank=1.Graphical abstract

BackgroundCentral venous catheter (CVC) poses a significant risk of infectious complications in children undergoing hemodialysis. A major concern is the occurrence of central line-associated bloodstream infections (CLABSIs), which are most critical and lead to significant morbidity.MethodsWe conducted a study in our pediatric hemodialysis center in King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia. We included pediatric patients (younger than 14 years old) with a positive central line blood culture who underwent hemodialysis from 2015 until 2023. We collected data pertaining to age, sex, underlying disease, clinical manifestations, and microbiological features, as well as their management strategies. We compared this group’s epidemiological and biochemical markers to a group of hemodialysis patients who did not develop CLABSI.ResultsIn our pediatric hemodialysis center, we have an overall incidence of 4.2 CLABSIs per 1,000 catheter days, with mainly gram-positive organisms. We found that more than half of the patients required hospitalization, indicating a lower threshold for admission in pediatric patients than adults. We also found that patients with catheter infections had higher white blood cell counts as well as neutrophils, which can be used to raise suspicion of catheter infection. Most patients (85%) did not require catheter removal and were treated with intravenous antibiotics only.ConclusionCLABSIs cause high morbidity and mortality; therefore, clinicians should have a high index of suspicion, especially in patients with fever and a high white blood cell count. Such patients require intravenous antibiotics, lock therapy in some cases, and, occasionally, catheter removal/replacement as indicated.

ABSTRACTObjectives:to relate sociodemographic characteristics with SARS-CoV-2 serology of minors under hemodialysis and their caregivers.Methods:a cross-sectional, descriptive study with anti-SARS-CoV-2 Spike immunoassay analysis.Results:ten patients and their companions were included before vaccination against COVID-19. The overall seroprevalence was 25% and 20% among patients, who had a mean age of 11.47 years, 70% of whom were male. All companions were women (100%), with a mean age of 38.41 years and 60% of mixed race. Half (50%) receive between 1 and 3 minimum wages, and 70% spend more than two hours commuting. As for the residences, all (100%) are made of masonry and have basic sanitation.Conclusions:the importance of routine tracking of COVID-19 cases and the impact of socioeconomic variables on the quality of life of children and family members is evidenced.

to relate sociodemographic characteristics with SARS-CoV-2 serology of minors under hemodialysis and their caregivers. a cross-sectional, descriptive study with anti-SARS-CoV-2 Spike immunoassay analysis. ten patients and their companions were included before vaccination against COVID-19. The overall seroprevalence was 25% and 20% among patients, who had a mean age of 11.47 years, 70% of whom were male. All companions were women (100%), with a mean age of 38.41 years and 60% of mixed race. Half (50%) receive between 1 and 3 minimum wages, and 70% spend more than two hours commuting. As for the residences, all (100%) are made of masonry and have basic sanitation. the importance of routine tracking of COVID-19 cases and the impact of socioeconomic variables on the quality of life of children and family members is evidenced.

ABSTRACT Precise dry weight evaluation holds significant importance for individuals with end-stage renal disease (ESRD) undergoing hemodialysis. Fluid overload is associated with an increased likelihood of mortality and morbidity. Ultrasonography aids in assessing dry weight and modifying dialysis prescription. OBJECTIVE: To assess the following in ESRD Patients by ultrasonography: Dry weight and effectiveness of fluid removal Adjust the dialysis prescription METHODOLOGY: A prospective cross-sectional study was carried out in the Pediatric Hemodialysis unit at The Children's Hospital Lahore, over 6 months from July to December 2022. The study included 30 children aged 5-16 years undergoing maintenance hemodialysis and exhibiting signs of overload. Ultrasound was performed for B-lines and IVC diameter before and after dialysis. Dialysis prescriptions were modified and patients were monitored through sequential scans. Data was analyzed using SPSS version 20. RESULTS: A total of 30 patients were enrolled with 53.3% being males. The average pre-dialysis weight was 25.39 kg, systolic blood pressure was 150.67 mmHg and diastolic blood pressure was 92.6 mmHg. Pre-dialysis pleural and pericardial effusions were observed in 86.7% patients, while B-lines were present in 63.3%. Majority of children (83%) were on twice-weekly dialysis and remaining were prescribed thrice weekly dialysis. A significant reduction in weight, blood pressure, pleural and pericardial effusion, B-lines, and IVC diameter was found after dialysis. Dialysis prescription was adjusted following the first session, with 80% subjects receiving thrice-weekly sessions, 16.7% daily, and 3.3% twice-weekly dialysis. CONCLUSION: Monitoring the appropriate fluid removal and adjustments to the dialysis prescription in hemodialysis patients can be accomplished using ultrasonography. Keywords: Dry weight, Ultrasound, B-lines, IVC, Dialysis frequency.

Chronic kidney disease in children is being increasingly recognised and reported worldwide, and the focus of paediatric dialysis planning has changed from acute care alone to encompass chronic care. In many parts of the world, haemodialysis for children is performed in adult units and is based on standards established for adults. This review proposes standards for paediatric haemodialysis, incorporating special requirements for children while simultaneously drawing from the adult experience. We discuss the optimum requirements, including space utilisation, equipment needed, water treatment facilities, disposables, safety standards, staffing needs, monitoring and maintenance, infection prevention, waste disposal and quality indicators. We also review recent advancements in the field that should be incorporated into future dialysis units and the steps required for achieving carbon neutrality and protecting the environment.

Abstract Background End stage Kidney disease (ESKD) is a major problem that is related to development of inflammation. Establishment of vascular access (VA) in the form of arteriovenous fistula (AVF) is mandatory to conduct efficient hemodialysis (HD). VA complications are one of the main causes of increase in morbidity and mortality in ESKD patients, which needs to be monitored regularly. Objective to evaluate the value of duplex ultrasound (DUS) and inflammatory markers (high sensitivity (hs) CRP, IL10, TNF) in early detection of vascular access complications in pediatric ESKD patients on regular HD. Methods This observational and interventional study was carried on 59 pediatric patients on regular HD at the PediatricDialysis Unit, Children’s Hospital, Ain Shams University, where DUS and serum level of inflammatory markers (hs-CRP, IL10, and TNF) were assessed once at time of enrollment (1) and the second at the time of early clinical suspicion of VA complication (2) which was detected by any abnormalities in physical examination. Results The study comprised 59 pediatric patients on regular HD, their mean (± SD) age was 13.97 (±2.65) years, 39 (56.5%) of them were males. The most common etiology of CKD was congenital anomalies of kidney and urinary track (CAKUT). Complications of the VA were reported in 55.9% of our studied patients, which include thrombosis, aneurysm, stenosis, early VA failure, pseudoaneurysm and perivascular hematoma, where thrombosis was the most frequent (28.8%), and was confirmed by DUS. AVF diameter (2), and flow volume (2) were significantly lower among patients with AVF thrombosis. The mean serum level of hs CRP was significantly elevated at the time of early clinical suspicion of AVF stenosis, and was confirmed by DUS, in comparison to its baseline level at time of enrollment of the study (0.08±0.08, 0.16±0.28 ng/mL, respectively, p = 0.04), serum IL10(1&amp;2) and TNF (2) were higher in this group. Early VA failure were reported in patients who had lower AVF diameter (1), PSV (1), EDV(1&amp;2),flow volume (1&amp;2), and higher AVF diameter (2), PSV (2). Conclusion DUS and hs-CRP are useful tools for early detection and, hence the management of AVF complications.

Accurate volume status assessment and dry weight achievement are the most challenging goals for a nephrologist. We aimed to evaluate the role of ultrasonographic parameters including lung ultrasound and inferior vena cava (IVC) measurements as practical methods of volume status assessment in children on hemodialysis by comparing them with established techniques, such as clinical evaluation and bioimpedance spectroscopy. A prospective cross-sectional study compared pre- and post-dialysis volume status using bioimpedance spectroscopy (BIS) parameters and clinical data with ultrasonographic lung B-lines and IVC parameters in children on regular hemodialysis. A total 60 children (mean age 9.4 ± 2.8years) were enrolled. Twenty patients (33.3%) were clinically overloaded to varying degrees (17 patients had mild to moderate signs of fluid overload and 3 patients had moderate to severe signs of fluid overload). All other patients (66.7%) were clinically euvolemic. Sonographic parameters were significantly lower post-dialysis than pre-dialysis, including lung B-line count and IVC diameter. IVC collapsibility index mean was significantly higher post-dialysis than pre-dialysis. There was a significant correlation between the lung B-line count, IVC parameters, and BIS-measured overhydration both before and after hemodialysis. Nine patients had ≥ 8 B-lines post-dialysis, only three of them were hypertensive. Clinical criteria alone are not specific for determining accurate fluid status in pediatric hemodialysis patients. Lung B-line score, IVC parameters, and BIS may be complementary to each other and to clinical data. Lung B-lines outperform IVC measurements and BIS in subclinical volume overload detection in pediatric hemodialysis patients.