Background: Arteriovenous fistula (AVF) is the vascular access of choice for End-Stage Renal Disease (ESRD) patients on maintenance hemodialysis. Arteriovenous fistula is the vascular access of choice for adequate hemodialysis.AVF dysfunction is one of the most important causes of morbidity and mortality in these patients. Aim: To access the frequency of dysfunctional AFVs using clinical examination among end-stage renal disease patients on thrice-weekly maintenance hemodialysis. Study design: Cross-sectional study Place and duration of study: Dialysis Unit, Nephrology Department, Sir Ganga Ram Hospital, Lahore from 21st January 2019, to 21st July 2019. Methodology: 177 patients who had end-stage renal disease and were on maintenance hemodialysis were enrolled. Fistulas were examined clinically. The presence and types of dysfunctional AVF were recorded. Results: Fifty three (29.9%) were females and 124 (70.1%) were females with mean age was 48±13.29 years. There were 44.1% diabetic, 91.0% hypertensive, and 44.1% both diabetic and hypertensive. The frequency of dysfunctional arteriovenous fistula was 30.5%. 123 (69.5%) patients had normal fistula, 13 (7.3%) had signs of outflow obstruction, 23 (13.0%) had aneurysm, 5 (2.8%) had signs of inflow obstruction, and 13 (7.3%) had a weak or absent thrill/bruit however no infection or steal syndrome was present. Conclusion: The frequency of dysfunctional arteriovenous fistula among patients on thrice-weekly maintenance hemodialysis is 30.5% on physical examination. Periodic physical assessment of AVF can reduce fistula failure rates. Key words: End-stage renal disease, Haemodialysis, Arteriovenous fistula

Background: Nail disorders are common in patients with chronic kidney disease on maintenance hemodialysis. Even though there are some studies regarding nail disorders in peritoneal dialysis and renal transplant patients, to the best of our knowledge, sparse local data is present on nail disorders among maintenance hemodialysis patients. Aim: To determine the frequency of nail disorders in patients with chronic kidney disease on maintenance hemodialysis. Study design: Cross-sectional study Place and duration of study: Dept of Nephrology, Sir Ganga Ram Hospital, Lahore from 1st February 2019 to 1st August 2019. Methodology: Two hundred and ninety two cases were enrolled. The nails of the patients were inspected and shot by utilizing a 10-megapixelcamera. The photos were subsequently reviewed independently by two dermatologists and one nephrologist. Results: There were 198 (67.8%) males and 94 (32.2%) females. The mean age was 47.3±12.4 years. The overall frequency of nail disorder in patients with chronic kidney disease on maintenance hemodialysis was 197(67.5%). According to nail disorders distribution, 119(40.8%) had half and half nail, while 56(19.2%) had splinter hemorrhage, 47(16.1%) had absent lunula, 16 (5.5%) had chromonychia, 15(5.1%) had Beau’s line, 19(6.5%) had melanonychia and 52(17.8%) had onycholysis. Conclusion: The frequency of nail problems in CKD patients treated by hemodialysis is 67.5%. This finding highlights the need for nail evaluation as a component of periodic examination in hemodialysis patients. Key words: Chronic kidney disease, Haemodialysis, Nail disorders.

Background: Anemia secondary to chronic kidney disease (CKD) is a major contributor to high morbidity and mortality among CKD patients. These patients develop iron deficiency anemia (IDA) either due to functional or absolute iron defects. KDIGO 2012 guidelines and 2013 European Renal Best Practice guidelines recommend iron replacement to achieve TSAT of 25-30% and the serum ferritin of 500 ng/ml. Aim: To determine the frequency of Iron-deficiency Anemia in end-stage renal disease patients on thrice-weekly maintenance hemodialysis. Study design: Cross-Sectional Study Place and duration of study: Dialysis Unit of Sir Ganga Ram Hospital, Lahore from 10th April 2019, to 10th October 2019. Methodology: One hundred and six cases were enrolled. Blood samples were taken and investigations to document anemia like hemoglobin levels, serum iron, serum TIBC, serum ferritin, and transferrin saturation were measured and IDA was recorded. Results: Seventy one (67.0%) were males and 35 (33.0%) were females. The mean age was 47.4±12.5 years. Iron deficiency anemia was found in 38 (35.8%) patients. Conclusion: Iron deficiency anemia is common among individuals with end-stage renal disease patients on thrice-weekly maintenance hemodialysis. Key words: End-stage renal disease (ESRD), Haemodialysis, Iron deficiency anemia (IDA)