الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease (CKD) is characterized by a gradual decline in renal function over time, initially asymptomatic but eventually leading to symptoms such as lower limb edema, fatigue, nausea, and vomiting. CKD is caused by various factors including hypertension, diabetes mellitus, genetic disorders, and autoimmune diseases. Diagnosis relies on measuring estimated glomerular filtration rate (eGFR), urinary albumin levels, and sometimes ultrasound or kidney biopsy. End-stage renal disease (ESRD) necessitates chronic hemodialysis, often requiring vascular access (VA) for dialysis procedures. Aim of Work: The aim is to evaluate electrophysiologic changes in peripheral nerves of the upper extremity after creating AV access in ESRD patients. Patients and methods: The study includes 50 ESRD patients requiring upper limb AV fistula or graft, admitted to Alexandria Main University Hospitals. Inclusion criteria involve limb suitability for AV access creation, while exclusion criteria encompass unsuitability for AV access, post-creation complications, and lost follow-up patients. The methods involved in the study encompassed a thorough evaluation of the 50 ESRD patients. Initial steps included comprehensive history-taking to document personal, medical, and surgical backgrounds, focusing on previous AV access and catheter insertion details. Clinical examination techniques were employed to assess upper limb pulsations and signs of venous hypertension. Subsequently, routine laboratory investigations were conducted, such as CBC, coagulation profile, and renal function tests. Electrophysiological evaluation was performed preoperatively and postoperatively to assess median, ulnar, and radial nerves for sensory and motor capacity, with parameters such as amplitude of nerve conduction, latency, and nerve conduction velocity being measured. Results: In this study, 50 patients with end-stage renal disease (ESRD) were evaluated, with the majority being male (76%). The mean age was 51.24 ± 13.61 SD. Some of the patients were diabetic (36%), hypertensive (80%), and cardiac patients (4%). The types of AV access created varied, with 52% BC shunts, 32% BB shunts, and 16% distal AVF. Sensory and motor parameters of the median, radial, and ulnar nerves including amplitude, latency and conduction velocity were tested showing insignificant changes post-AVF creation, except for a significant increase in sensory median nerve amplitude (p = 0.041). And a significant decrease in motor ulnar nerve amplitude postoperatively (p = 0.025), though without clinical symptoms. Diabetic and non-diabetic groups did not show significant differences in sensory parameters, but there is a significant decrease in motor radial nerve amplitude in diabetics post-AVF creation (P = 0.006), other motor nerve parameters displayed no significant differences between diabetic and non-diabetic groups. Regardless of the type of arteriovenous fistula (AVF) created, there are no statistically significant differences in sensory nerve parameters in the upper limb. Conversely, the impact of different AVF types on motor nerves postoperatively compared to preoperative status is obvious. The analysis reveals a statistically significant difference in motor ulnar nerve conduction velocity (CV) among the three shunt types (p = 0.036). Specifically, the brachio-basilic (BB) group exhibits the greatest impact, with the lowest mean and widest standard deviation (Mean ± SD -9.16 ± 16.0). Additionally, a significant difference is observed when comparing BB and brachio-cephalic (BC) groups
(p = 0.012). Notably, distal AVF shows the least effect on motor nerves across various shunt types, evident by the smallest standard deviation in mean values of different motor nerve parameters