Variability of toe pressures during haemodialysis: comparison of people with and without diabetes; a pilot study.

IF 2.5 3区医学 Q1 ORTHOPEDICS

Journal of Foot and Ankle Research Pub Date : 2023-07-10 DOI:10.1186/s13047-023-00642-y

Rachel Carle, Peta Tehan, Sarah Stewart, David Semple, Andrew Pilmore, Matthew R Carroll

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引用次数: 0

Abstract

Background: Diabetes, end stage renal disease (ESRD), and peripheral arterial disease (PAD) are associated with a higher risk of diabetes-related lower limb amputation. Timely identification of PAD with toe systolic blood pressure (TSBP) and toe-brachial pressure index (TBPI) is critical in order to implement foot protection strategies to prevent foot complications in people with ESRD. There is limited evidence describing the effect of haemodialysis on TSBP and TBPI. This study aimed to determine the variability of TSBP and TBPI during haemodialysis in people with ESRD, and to determine whether any observed variability differed between people with and without diabetes.

Methods: TSBP and TBPI were taken before dialysis (T1), one hour into dialysis (T2) and in the last 15 min of dialysis (T3) during a single dialysis session. Linear mixed effects models were undertaken to determine the variability in TSBP and TBPI across the three time points and to determine whether this variability differed between people with and without diabetes.

Results: Thirty participants were recruited, including 17 (57%) with diabetes and 13 (43%) with no diabetes. A significant overall reduction in TSBP was observed across all participants (P < 0.001). There was a significant reduction in TSBP between T1 and T2 (P < 0.001) and between T1 and T3 (P < 0.001). There was no significant overall change in TBPI over time (P = 0.62). There was no significant overall difference in TSBP between people with diabetes and people with no diabetes (mean difference [95% CI]: -9.28 [-40.20, 21.64], P = 0.54). There was no significant overall difference in TBPI between people with diabetes and people with no diabetes (mean difference [95% CI]: -0.01 [-0.17, 03.16], P = 0.91).

Conclusion: TSBP and TBPI are an essential part of vascular assessment of the lower limb. TBPI remained stable and TSBP significantly reduced during dialysis. Given the frequency and duration of dialysis, clinicians taking toe pressures to screen for PAD should be aware of this reduction and consider how this may have an impact on wound healing capacity and the development of foot related complications.

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血液透析期间脚趾压力的变异性:糖尿病患者和非糖尿病患者的比较一项初步研究。

背景:糖尿病、终末期肾病(ESRD)和外周动脉疾病(PAD)与糖尿病相关下肢截肢的高风险相关。及时识别伴有脚趾收缩压(TSBP)和脚趾肱压指数(TBPI)的PAD对于实施足部保护策略以预防ESRD患者的足部并发症至关重要。关于血液透析对TSBP和TBPI影响的证据有限。本研究旨在确定ESRD患者血液透析期间TSBP和TBPI的变异性，并确定是否有观察到的变异性在糖尿病患者和非糖尿病患者之间存在差异。方法:单次透析时，分别在透析前(T1)、透析后1 h (T2)和透析后15 min (T3)测定患者的TSBP和TBPI。采用线性混合效应模型来确定三个时间点上TSBP和TBPI的变异性，并确定这种变异性在糖尿病患者和非糖尿病患者之间是否存在差异。结果:招募了30名参与者，其中17名(57%)患有糖尿病，13名(43%)没有糖尿病。所有参与者均观察到TSBP总体显著降低(P结论:TSBP和TBPI是下肢血管评估的重要组成部分。透析期间TBPI保持稳定，TSBP显著降低。考虑到透析的频率和持续时间，临床医生通过足趾压力筛查PAD应该意识到这种减少，并考虑这可能对伤口愈合能力和足部相关并发症的发展产生的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Foot and Ankle Research ORTHOPEDICS-

CiteScore

4.50

自引率

10.30%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Foot and Ankle Research, the official journal of the Australian Podiatry Association and The College of Podiatry (UK), is an open access journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders. Journal of Foot and Ankle Research covers a wide range of clinical subject areas, including diabetology, paediatrics, sports medicine, gerontology and geriatrics, foot surgery, physical therapy, dermatology, wound management, radiology, biomechanics and bioengineering, orthotics and prosthetics, as well the broad areas of epidemiology, policy, organisation and delivery of services related to foot and ankle care. The journal encourages submissions from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care. The Australian Podiatry Association and the College of Podiatry (UK) have reserve funds to cover the article-processing charge for manuscripts submitted by its members. Society members can email the appropriate contact at Australian Podiatry Association or The College of Podiatry to obtain the corresponding code to enter on submission.