Objective:The objective of this study was to use a portable laser Doppler flowmeter (LDF) to measure the toe blood flow and pulse amplitude as a screening test for peripheral arterial disease (PAD) in dialysis patients and compare the diagnostic abilities of the aforementioned parameters measured using an LDF with those of the ankle-brachial index (ABI) and toe brachial index (TBI). Methods: The 14 patients in this retrospective study received maintenance hemodialysis (HD). We measured the blood flow and pulse amplitude on the ventral side of the first toe with a portable LDF while the patients were undergoing an HD session. The correlations between the blood flow/pulse amplitude in the toe and the ABI/TBI were examined. Results: Both the ABI and TBI had a strong correlation with pulse amplitude. The sensitivity and specificity of the pulse amplitude measured with the LDF for detecting PAD in HD patients as determined by a receiver operating characteristic curve analysis were 1.00 and 0.88, respectively. Conclusion: Measuring the pulse amplitude in the toe with a portable LDF may serve as a simple and useful screening test for PAD in HD patients.
BACKGROUND AND AIMS The dialysis disequilibrium syndrome (DDS) is a major complication in hemodialysis patients in the initiation phase. Since urea removal restriction is an effective method to prevent DDS, a reduced dialysis dose is used in the initiation phase in hemodialysis patients. However, despite this, some patients still develop DDS in the initiation phase. Hemodiafiltration with intermittent infusion (I-HDF) provides intermittent infusion during dialysis, which can reduce the imbalance between the intravascular and interstitial concentrations, thus maintaining a high plasma osmolarity and potentially high plasma osmolarity, lowering the incidence of DDS. The aim of the present study was to clarify whether starting the treatment with I-HDF is useful for preventing DDS in hemodialysis patients in the initiation phase. METHOD Since January 2021, we have used I-HDF at the start of the treatment in patients being initiated on hemodialysis at our hospital. We conducted a retrospective review to examine if there were any changes in the incidence of clinical symptoms such as DDS or the mean blood pressure during dialysis with this mode change. The participants in this study included 11 patients who were started on treatment with conventional low-dose hemodialysis (HD group) (10 males/1 female; 5 diabetic, 6 non-diabetic; mean age, 73.7 years; SD 8.3) and 14 patients who were started on treatment with I-HDF (I-HDF group) (12 males/2 females; 12 diabetic, 2 non-diabetic; mean age, 66.8 years; SD 16.1). We compared the prevalence of symptoms of DDS (headache, nausea, vomiting, leg cramps, fatigue and hypotension), the normalized dialysis dose (spKt/V), the urea nitrogen (UN), serum albumin (Alb), fluid removal rate and mean blood pressure in the HD and I-HDF groups at first treatment. The treatment conditions were FA-150F membrane for the HD group and FIX-170E membrane for the I-HDF group, with a blood flow rate of 150 mL/min, dialysate flow rate of 500 mL/min and treatment time of 3-h in both groups. I-HDF was carried out with five infusions of 150–200 mL/min for one minute by back filtration of the dialysate every 30 minutes. RESULTS A significantly lower incidence of DDS was noted in the I-HDF group, with 3 events in the I-HDF group as compared with 17 events in the HD group (P < .01, chi-squared test). There was no significant difference in the spKt/V, UN, Alb, or fluid removal rate between the two groups (P = .80, P = .28, P = .96 and P = .20, respectively). The mean blood pressure was significantly lower in the HD group than in the I-HDF group (P < .05, t-test). These results indicated that the incidence of DDS could be reduced by starting treatment with I-HDF in patients being initiated on hemodialysis, because the intentional loading of fluid by intermittent infusion may enhance plasma refilling and have a positive effect on suppressing any rapid changes in the plasma osmolality. CONCLUSION I-HDF was useful for maintaining the blood pressure and reducing the incidence of dialysis disequilibrium syndrome in the initiation phase in hemodialysis patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.