Seerat NOOR, Asad ULLAH, Ayyaz AHMAD, Mahnoor IQBAL, MUNTAHA, Sania Abdul SHAKOOR
Medical Science and Discovery - 2026;13(8):198-205
Objective: Hemodialysis (HD) remains the primary renal replacement therapy for patients with end-stage renal disease (ESRD). Although arteriovenous fistulas (AVFs) are the preferred vascular access and may appear normal on Doppler ultrasonography, patients can still experience hemodynamic instability during dialysis. To assess hemodynamic changes during hemodialysis in an ESRD patient and to evaluate arteriovenous fistula function using Doppler ultrasound. Materials and Methods: A retrospective case study was conducted at Prime Radiology Centre, Faisalabad, Punjab, Pakistan, reviewing one ESRD patient's maintenance hemodialysis records over 87 sessions (4 November 2024 - 25 February 2026). Data were extracted from dialysis treatment charts, medical records, and Doppler ultrasonography reports. Pre-, intra-, and post-dialysis blood pressure, body weight, and AV fistula flow characteristics were recorded. Normality of paired differences was assessed with the Shapiro-Wilk test; as normality was not met, the Wilcoxon signed-rank test was used to compare intra- and post-dialysis blood pressure. Results: Complete blood pressure data were available for 74-84 of the 87 sessions depending on the timepoint. Doppler ultrasound demonstrated a patent, normally functioning AV fistula with adequate blood flow and no evidence of thrombosis, infection, pseudoaneurysm, or mechanical failure. Using standard clinical thresholds (systolic >=140 mmHg or diastolic >=90 mmHg), hypertension was present pre-dialysis in 63.5% of assessed sessions and intra-dialysis in 45.2%; post-dialysis hypotension (systolic <90 mmHg) occurred in 1.2%. Intra-dialysis systolic blood pressure was significantly higher than post-dialysis systolic blood pressure (Wilcoxon signed-rank test, W = 367.5, n = 83, p = 0.023), while the diastolic blood pressure change was not significant (p = 0.139). Minor complications included first-use syndrome (11.6%), nausea (5.8%), headache (5.8%), and vomiting (5.8%). Conclusion: Doppler ultrasonography is a reliable tool for assessing AVF patency and function; however, normal Doppler findings do not exclude intradialytic blood pressure fluctuations, underscoring the need for routine hemodynamic monitoring during hemodialysis.
