The Relation between the Level of Serum Tumor Necrosis Factor – Alpha and Hemodialysis Adequacy in Diabetic and Non Diabetic Patients on Maintenance Hemodialysis

Background: Hemodialysis is still the most common renal replacement therapy (RRT) modality in end stage renal disease patients (ESRD), the first problem to be faced when choosing hemodialysis for patients with ESRD is the vascular access, dia¬lysis delivery should be adequate not only to improve quality of life but also to prolong sur¬vival, quality of life adjusted for life expectancy defined kt/v of 1.3 as the optimal cost-effective dialysis, An ideal access delivers a flow rate to the dialyzer adequate for the dialysis prescription, has a long use-life, and has a low rate of complications (eg, infection, stenosis, thrombosis, aneurysm, and limb ischemia). Of available accesses, the surgically created fistula comes closest to fulfilling these criteria, working fistula must have all the following characteristics; blood flow adequate to support dialysis which usually equates to blood flow greater than 600 ml/min, a diameter greater than 0.6 cm, with a location accessible for cannulation and a depth of approximately 0.6 cm (ideally between 0.5 and 1cm) from the skin surface. In hemodialysis patients with an arteriovenous fistula (AVF), access failure is primarily due to fistula stenosis, which predisposes to thrombosis and subsequent access loss. The risk for access failure differs individually, Fistula stenosis is histologically characterized by endothelial cell injury and intimal hyperplasia induced by factors like TNF-α, which could induce proliferation of vascular smooth muscles leading to subsequent intimal hyperplasia. Resulting in fistula stenosis and subsequent access failure. TNFalpha influences the risk for hemodialysis access failure in diabetic ESRD patients there is advanced calcified atherosclerosis which leads to frequently inadequate arterial inflow and eventually also to venous run-off problems. So ESRD patients with diabetes have worse access survival rates and hemodialysis adequacy.