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Clinical Research
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Preliminary assessment of hemodialysis effect on perfusion pressure in diabetic and nondiabetic patients Nairmeen Awad Haller, PhD, Dawn Sues, RN, Brian Cabral, MD, Monica Cating, MD, Antonio Marinos, MD, Gina Slipka-Marinos, MD, Kush Patel, BS, Susan Ray, MD, David Kay, MD Introduction: Patients with diabetes are at greater risk of developing chronic foot wounds or ulcers. In 2002, approximately 83% of all diabetic patients with end- stage renal disease required hemodialysis. There is a concern that hemodialysis may disrupt perfusion of the extremities causing further impairment of the wound healing process in these individuals. Current laser Doppler technology provides the opportunity to identify changes in vascular performance in a non-invasive fashion. The objective of this study was to identify differences in perfusion pressures between diabetic and non-diabetic patients before, during, and after the hemodialysis session. Methods: Patients currently requiring hemodialysis and meeting all of the inclusion criteria were included in this preliminary study. Serial peripheral perfusion and oxygenation measurements were obtained before, midway, and at the conclusion of the dialysis session using a transcutaneous laser Doppler system Results: Preliminary data were assessed using the Student's t test. The data indicate a significant difference between toe perfusion pressures of diabetic and nondiabetic patients (n=23 and 12 measurements, respectively) during (P<0.01) and immediately following (P<0.05) the dialysis session. No difference was detected in toe pressure prior to the dialysis session, in any of the skin perfusion measurements, or in the oxygenation measurements Discussion: Our data suggest that hemodialysis may significantly affect perfusion to the lower extremities in diabetic patients. While it is too early to make definite conclusions, trends from these data indicate the need to continue this study as originally designed. Consequently, reassessment of the hemodialysis protocol or techniques used to heal diabetic wounds and ulcers may be justified in order to improve the chances of a successful treatment and better avoid amputation due to infection. This study allows clinicians to better understand the effect of hemodialysis on distal perfusion, and subsequently determine to what extent the periphery may be compromised. Akrnal M. Hemodialysis in diabetic patients. Am J Kidney Dis. 2001;38(4):SI95Ð199. National Diabetes Fact Sheet. American Diabetes Association Web site. Available at: www.diabetes.org/diabetes-statistics/national-diabetes-fact-sheet.jsp. Accessed May 17, 2005. Treatment Modalities. United States Renal Data System Web site. Available at: www.usrds.org/2004/ref/D_tables_04.pdf. Accessed May 17, 2005. McMillan DE. Development of vascular complications in diabetes. Vasc Med.1997;2(2):132Ð42.. .Pecoraro RE. The non-healing diabetic ulcer-a major cause for limb loss. Clinical and Experimental Approaches to Dermal and Epidermal Repair. Normal and Chronic Wounds. Barbul A, Caldwell, MD, Eaglestein WH, eds. New York, NY, Wiley-Liss, Inc. 1991:27Ð43. Gschwandtner ME, Ambrozy E, Maric S, et al. Microcirculation is similar in ischemic and venous ulcers. Microvasc Res. 2001;62(3):226Ð35. The multi-functional PeriFlux System: Innovations in Microvascular Diagnosis. PERIMED Web site. Available at www.perimed.se/p_Products/Periflux.htm. Accessed May 19, 2005. |
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