Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures

Paraskevas, Kosmas I.; Koupidis, Sotirios A; Tzovaras, Alexandros; Nikolaou, Achilleas; Mikhailidis, Dimitri P.

doi:10.1007/s11255-010-9892-7

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…One study in dialysis patients found the low sensitivity of ABI of 49% and a high specificity of 94.8%. 14 These findings agreed with a separate study using whole-body MRA (magnetic resonance angiography) as a gold standard test, which found the sensitivity of ABI as only 20% for the diagnosis of PAD in risky populations, when MRA showed at least 50% stenosis of lower extremity arteries. 18 In that particular study, additionally, specificity was noted as 90%, which was also similar to the figure that we described.…”

Section: Discussionsupporting

confidence: 88%

“…5 Nonetheless, as far as it is known, ABI alone has been proved to be insufficient for PAD diagnosis, particularly in patients with chronic kidney disease and DM, due to interfering false-elevation. 6,14-17 We demonstrated that the sensitivity of ABI in ESRD patients was low (34.96%), while the specificity was relatively high (85.91%). These findings discouraged ABI being used as a screening method due to low sensitivity.…”

Section: Discussionmentioning

confidence: 82%

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Pole Test and Ankle-Brachial Index by Using Doppler Ultrasound for Peripheral Arterial Disease in End-Stage Renal Disease Patients

Tungsrirut

Taptiang

Charoenkarn

et al. 2020

The International Journal of Lower Extremity Wounds

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Peripheral arterial disease (PAD) causes great disability in end-stage renal disease (ESRD). Pole test is a simplified test utilizing the basis of Doppler ultrasound invented to correct false elevation in ankle-brachial index (ABI) in diabetic patients with severe calcification of the tibial artery. However, the role of pole test in ESRD patients is still unclear. The aim of this study was to explore the sensitivity, specificity, and overall utility of pole tests in such patients. One hundred and four patients were recruited and examined with 3 tests: pole test, ABI, and toe-brachial index, the latter serving as the gold standard. Receiver operating characteristic analysis was performed using SPSS version 22.0. The sensitivity, specificity, and other diagnostic values of ABI and pole tests were calculated. There were 104 ESRD patients enrolled. Pole tests showed to have low probability to provide accurate results (area under the curve = 0.505, standard error = 0.042). Low sensitivity of ABI (34.96%) can be observed in ESRD patients. Specificity, positive predictive value, and negative predictive value of ABI in all cases were, respectively, 85.91%, 81.13%, and 43.26%. It is concluded that pole test accuracy seemed to be limited in ESRD patients. ABI was found to be confounded by medial arterial calcification, resulting in low sensitivity as well. The results of this study permit the observation that an optimal tool for screening peripheral arterial disease in ESRD patients remains to be discovered.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 82%

Pole Test and Ankle-Brachial Index by Using Doppler Ultrasound for Peripheral Arterial Disease in End-Stage Renal Disease Patients

Tungsrirut

Taptiang

Charoenkarn

et al. 2020

The International Journal of Lower Extremity Wounds

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“…These associations underscore the importance of early disease detection and initiation of therapeutic measures for PVD and cardiac comorbidity. 13,14 …”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Frailty in a Large Prevalent Cohort of Hemodialysis Patients

Kutner

Zhang

Huang

et al. 2014

The American Journal of the Medical Sciences

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Background Although persons with kidney disease, including those dependent on dialysis, often present clinically with signs and symptoms consistent with frailty, there is limited information about sociodemographic and clinical risk factors that may be associated. Methods 745 patients undergoing hemodialysis (HD) 2009–2011 in 7 Atlanta dialysis clinics and 7 San Francisco Bay Area dialysis clinics were assessed using the validated Fried frailty index (recent unintentional weight loss, reported exhaustion, low grip strength, slow walk speed, low physical activity) that defines frailty as the presence of 3 or more criteria. Study coordinators interviewed participants; measured grip strength, walk speed and body composition; and reviewed records for clinical and laboratory parameters. Logistic regression models were used to estimate the association of patient characteristics with frailty. Results In adjusted analyses, peripheral vascular disease (PVD) and cardiac diseases including dysrhythmia, atrial fibrillation, tachycardia, pericarditis, and cardiac arrest were associated with higher odds for frailty, while black race and higher serum albumin concentration were associated with lower odds for frailty. Conclusions In multivariable analyses, HD patients’ risk for frailty, as assessed by the presence of 3 or more criteria that comprise the Fried frailty index, was increased in association with PVD and cardiac conditions such as dysrhythmia and atrial fibrillation, and was decreased for those with higher serum albumin concentration and for blacks compared with whites. Among patients who met the Fried definition of frailty, 78% scored as frail on walk speed and 56% scored as frail on grip strength, the 2 physical performance measures.

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“…14 Besides PAD, hemodialysis patients may have concomitant DM, an independent predictor of mortality associated with considerable vascular burden. 15 Screening for PAD using the ABI may therefore lead to initiation of preventive treatments (eg, statins, Mediterranean diet, weight loss, exercise rehabilitation and, if indicated, early revascularization) to avoid lower limb amputations, CV events, and CV death. [14][15][16] Emerging evidence indicates that patients with PAD are at high risk of developing lung and other cancers (probably mainly related to high rate of smoking and improved survival if appropriate preventive measures are implemented).…”

Section: Benefits Of Screeningmentioning

confidence: 99%

Screening for Peripheral Arterial Disease Using the Ankle-Brachial Index in Diabetic and Other High-Risk Patients

2015

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Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures

Cited by 7 publications

References 21 publications

Pole Test and Ankle-Brachial Index by Using Doppler Ultrasound for Peripheral Arterial Disease in End-Stage Renal Disease Patients

Pole Test and Ankle-Brachial Index by Using Doppler Ultrasound for Peripheral Arterial Disease in End-Stage Renal Disease Patients

Risk Factors for Frailty in a Large Prevalent Cohort of Hemodialysis Patients

Screening for Peripheral Arterial Disease Using the Ankle-Brachial Index in Diabetic and Other High-Risk Patients

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