Upper Extremity Complications in Patients With Chronic Renal Failure Receiving Haemodialysis

Abstract

Limited data are available about disability associated with upper extremity complications in patients who receive haemodialysis for end-stage renal disease. In this study of 123 patients receiving haemodialysis, the mean Disabilities of the Arm, Shoulder and Hand (DASH) score was 31 ± 22 points, indicating markedly greater disability than in a normal population. Dupuytren's contracture was the most frequent deformity. Brachial, radial and ulnar pulses were present in most upper limbs, but 14 (14%) of 102 patients had poor arterial perfusion pressures. Diabetic patients had residual or complete loss of protective sensation more frequently than nondiabetic patients. Motor testing with the index finger abduction and fifth finger flexion tests showed a significantly greater frequency of weakness in diabetic than nondiabetic patients. In summary, upper extremity disability was noted in haemodialysis patients, including loss of protective sensation and motor strength, both in diabetic and nondiabetic subjects.

Revascularization Options for Terminal Distal Ischemia

“…1 Most of these will show at least digital artery occlusion, and many will have ulnar artery occlusion on vascular studies. 2 Young diabetics with renal failure are at risk for critical hand ischemia, 3 and those on dialysis are at even higher risk. 3 These patients suffer from calcific vascular disease involving the major vessels and digital vessels in the upper extremity, and the presence of an arteriovenous fistula in the more proximal arm can lead to significant "steal" from the already compromised native circulation.…”

“…2 Young diabetics with renal failure are at risk for critical hand ischemia, 3 and those on dialysis are at even higher risk. 3 These patients suffer from calcific vascular disease involving the major vessels and digital vessels in the upper extremity, and the presence of an arteriovenous fistula in the more proximal arm can lead to significant "steal" from the already compromised native circulation. The presence of digital arterial occlusion in both of these groups of patients makes management of their ischemia challenging.…”

Assessment of hand dysfunction in patients receiving hemodialysis through arteriovenous fistula

“…Tissue damage due to such abnormal electrolyte levels and metabolic condition may cause musculoskeletal system disorders and neurologic disorders [1]. These disorders include muscle weakness and abnormal sensory function [2].…”

“…Upper extremity complications throughout the course of time beginning with haemodialysis developing regardless of the area and type of vascular intervention were established by studies. These complications include peripheral nerve entrapment neuropathies, avoidance of using the extremity having the vascular access, edema occurring in the upper extremity due vascular insufficiency, swelling, sweating issues, and insufficiency in upper extremity functions [1].…”

Unusual vascular access methods for chronic renal failure

“…Unless renal transplantation fails, renal replacement should be maintained to survive, which can be achieved using hemodialysis or peritoneal dialysis. [1] Vascular access is the mainstay of the hemodialysis in this patient population. It has been proved that autogenous arteriovenous fistulas (AVFs) are superior than the prosthetic arteriovenous grafts or central venous catheters.…”