Digital pressure with laser Doppler flowmetry is better than photoplethysmography to characterize peripheral arterial disease of the upper limbs in end-stage renal disease patients

OBJECTIVE: To review the current evidence for use of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) in nontraditional lipid-related applications, including acute coronary syndromes, peripheral arterial disease, stroke, and renal disease, and to describe ongoing trials evaluating the role of statins in these conditions. DATA SOURCES: Clinical literature was identified by a MEDLINE search (1990–November 2002) using ≥1 of the following search terms: acute coronary syndrome(s), angina pectoris, atherosclerosis, atorvastatin, clinical trials, diabetes mellitus, end-stage renal disease, fluvastatin, lovastatin, myocardial infarction, peripheral arterial disease, pravastatin, simvastatin, statins, and stroke. Treatment guidelines issued by professional and governmental organizations, such as the American Diabetes Association, American Heart Association, National Cholesterol Education Program, National Kidney Foundation, and National Stroke Foundation, were reviewed. STUDY SELECTION AND DATA EXTRACTION: Articles identified from the data sources were included if they pertained to the conditions described in the objectives and provided unique information concerning use of statins. DATA SYNTHESIS: Substantial evidence exists for the use of statins in acute coronary syndromes. Meta-analyses of data from major clinical trials indicate that statins prevent first and recurrent stroke, and large-scale trials are underway to evaluate the efficacy of statins in this setting. Accumulating evidence suggests that statins may be beneficial in reducing the morbidity and mortality associated with peripheral arterial disease and end-stage renal disease, and results from ongoing trials may confirm these benefits. Statins may also have a future role in amelioration of other conditions associated with atherosclerosis, such as diabetes mellitus. CONCLUSIONS: A large body of evidence supports the evaluation of statins in clinical settings beyond primary and secondary prevention of morbidity and mortality associated with coronary atherosclerosis.

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

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620951528 ◽

2020 ◽

Vol 19 (4) ◽

pp. 359-363

Author(s):

Nutthanun Tungsrirut ◽

Krittitee Taptiang ◽

Kairawee Charoenkarn ◽

Pavarit Piyachon ◽

Pitipong Srisittipoj ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

End Stage Renal Disease ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Peripheral Arterial ◽

Low Sensitivity ◽

Stage Renal Disease ◽

End Stage ◽

Sensitivity Specificity ◽

Esrd Patients

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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Correction: The Risk of Peripheral Arterial Disease after Parathyroidectomy in Patients with End-Stage Renal Disease

PLoS ONE ◽

10.1371/journal.pone.0158930 ◽

2016 ◽

Vol 11 (7) ◽

pp. e0158930

Author(s):

Yueh-Han Hsu ◽

Hui-I Yu ◽

Hsuan-Ju Chen ◽

Tsai-Chung Li ◽

Chih-Cheng Hsu ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Arterial Disease ◽

Peripheral Arterial ◽

Stage Renal Disease ◽

End Stage

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Intradialytic Muscle Cramp and its Association with Peripheral Arterial Disease in End Stage Renal Disease Patients on Hemodialysis

Journal of Nepal Medical Association ◽

10.31729/jnma.2795 ◽

2014 ◽

Vol 52 (196) ◽

pp. 967-971 ◽

Cited By ~ 1

Author(s):

Madhav Ghimire ◽

Sanjib Kumar Sharma ◽

Romila Chimoriya ◽

Gopal Chandra Das

Keyword(s):

Peripheral Arterial Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Arterial Disease ◽

Hemodialysis Patients ◽

Muscle Cramp ◽

Muscle Cramps ◽

Peripheral Arterial ◽

Stage Renal Disease ◽

End Stage

Introduction: Muscle cramp is a common intradialytic complication observed in hemodialysis patients. Similarly Peripheral arterial disease is a common condition in the hemodialysis population. No study on intradialytic muscle cramp and its association with Peripheral arterial disease is yet reported from Nepal. Methods: Fifty patients with a diagnosis of End Stage Renal Disease who were on hemodialysis were studied over a period of one year. Muscle cramp was defined clinically as contractions of a large muscle group and Peripheral arterial disease was diagnosed on the basis of the ankle –brachial index. Chi square (X2) test was used to determine the association between Intradialytic Muscle cramps and Peripheral Arterial Disease. Results: A total of 50 End Stage Renal Disease patients were analyzed. The mean age of the patient was 49.81±12.63 years. The major causes of End Stage Renal Disease in the study population was Chronic Glomerulonephritis 40 % (n=20). Muscle cramps were present in 26% (n=13) cases. Peripheral arterial disease was present in 30% (n=15) of patients. However there was no statistically significant association between the presence of Intradialytic Muscle cramps and peripheral arterial disease (p value =0.18) Conclusions: Intradialytic Muscle cramps and peripheral arterial disease were common occurrence in end stage renal disease patients on hemodialysis patients, however there was no association between the presence of intradialytic Muscle cramps and peripheral arterial disease. Keywords: end stage renal disease; intradialytic muscle cramps; peripheral arterial disease.

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Propionyl-L-Carnitine Therapy: Effects on Endothelin-1 and Homocysteine Levels in Patients with Peripheral Arterial Disease and End-Stage Renal Disease

Kidney & Blood Pressure Research ◽

10.1159/000094363 ◽

2006 ◽

Vol 29 (2) ◽

pp. 100-107 ◽

Cited By ~ 13

Author(s):

Salvatore Santo Signorelli ◽

Pasquale Fatuzzo ◽

Francesco Rapisarda ◽

Sergio Neri ◽

Margherita Ferrante ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Arterial Disease ◽

Endothelin 1 ◽

Peripheral Arterial ◽

Stage Renal Disease ◽

End Stage

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Prevalence of Peripheral Arterial Disease among End Stage Renal Disease Patients

QJM ◽

10.1093/qjmed/hcaa041.010 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R R W Morkos ◽

A M Shahan ◽

A S Elserafy ◽

H F Hanna

Keyword(s):

Peripheral Arterial Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Arterial Disease ◽

Control Group ◽

Asymptomatic Patients ◽

Peripheral Arterial ◽

Stage Renal Disease ◽

End Stage ◽

Regular Hemodialysis

Abstract Background Patients with End Stage Renal Disease are more susceptible to develop Peripheral Arterial Disease. So, screening is helpful for early diagnosis. Objectives The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD. Methods The study included 100 asymptomatic patients on regular hemodialysis and below 60 years old to be screened for presence of PAD. All selected patients have been subjected to ABI assessment using the Doppler. It was found that the prevalence of PAD among ESRD patients is 26% of which 80.8% had bilateral PAD and 19.2% had unilateral disease. The results showed that females had statistically significant higher risk of developing PAD than males. The study showed also that A1C level in patients who have no diabetes carries statistically significant results. The mean A1C level for the study group was 5.56 ± 0.70 and the control group was 4.92 ± 0.73. The p value was 0.000. The A1C level cut off value was > 5.3. Conclusion Renal impairment is an important risk factor for developing PAD in absence of traditional risk factors such as DM, hypertension, or dyslipidemia. Prevalence of PAD was 26% in our study. ABI is a simple non-invasive modality of screening for PAD. Females are at higher risk to develop PAD than males by ∼ 2.7 fold. Although diabetes is absent, A1C level > 5.3 is significantly correlating with the risk of PAD.

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Prevalence of Peripheral Arterial Disease (PAD) in End Stage Renal Disease (ESRD) Patients on Hemodialysis: A Study from Central Nepal

Kathmandu University Medical Journal ◽

10.3126/kumj.v12i3.13714 ◽

2015 ◽

Vol 12 (3) ◽

pp. 181-184 ◽

Cited By ~ 3

Author(s):

M Ghimire ◽

B Pahari ◽

G Das ◽

GC Das

Keyword(s):

Peripheral Arterial Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Ankle Brachial Index ◽

Arterial Disease ◽

P Value ◽

Peripheral Arterial ◽

Stage Renal Disease ◽

End Stage

Background Peripheral arterial disease is a common condition in the hemodialysis population with an estimated prevalence ranging from 17-48%. Many studies have been conducted to know the prevalence of peripheral vascular disease in hemodialysis population. However no such study has been conducted so far in Nepal.Objective This study was carried out with an objective to assess the prevalence of Peripheral Arterial Disease in End Stage Renal Disease Patients on Hemodialysis.Method Fifty patients with a diagnosis of End Stage Renal Disease (irrespective of the underlying cause), and those who were on hemodialytic support for more than 3 months were studied over a period of one year. Peripheral arterial disease was diagnosed on the basis of the ankle –brachial index, which was the ratio of the resting systolic blood pressure in the arteries of the ankle to that of the brachial artery, measured by using a standard mercury manometer with a cuff of appropriate size and the Doppler ultrasound. Patients with ankle –brachial index ?0.9 were considered positive for peripheral arterial disease.Result A total of 50 End Stage Renal Disease patients were analyzed. The mean age of the patient was 49.81±12.63 years. The age range was from 18- 79 years. Majority of them were males 64% (n=32). Peripheral arterial disease defined by ankle –brachial index ?0.9 was present in 30% (n=15) of patients. The three major cause of End Stage Renal Disease in the study population was Chronic Glomerulonephritis 40 % (n=20), Type 2 Diabetes Mellitus 28 % (n=14) and Hypertension 24 % (n=12). Type 2 Diabetes Mellitus was the commonest cause 53% (n=8) of End Stage Renal Disease in patients with peripheral arterial disease followed by hypertension 33% (n=5). On univariate analysis, peripheral arterial disease was found to be significantly associated with age >40 years (p value= 0.003; OR=14.8; CI=1.75-125.27), Type 2 Diabetes Mellitus (p value= 0.009; OR=5.4; CI=1.44-21.14), parasthesia of lower limbs (p value= 0.001; OR=10; CI-2.31-43.16), and intact PTH >300 ng/ml (p value =0.006; OR=5.7; CI=1.55-21.50). However on multivariate analysis only parasthesia of lower limbs and intact PTH >300 ng/ml were significantly and independently associated with peripheral arterial disease, while other variables were not significant.Conclusion Peripheral arterial disease was common occurrence in End Stage Renal Disease patients on hemodialysis. Ankle –brachial index needs to be included as a routine assessment in End Stage Renal Disease patients to detect peripheral arterial disease at its earliest.Kathmandu University Medical Journal Vol.12(3) 2014; 181-184

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