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

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

doi:10.1186/s13047-023-00642-y

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

J Foot Ankle Res. 2023 Jul 10;16(1):42. doi: 10.1186/s13047-023-00642-y.

Authors

Rachel Carle¹, Peta Tehan², Sarah Stewart^{3

4}, David Semple^{5

6}, Andrew Pilmore⁵, Matthew R Carroll^{7

8}

Affiliations

¹ Community and Long-Term Conditions Directorate, Te Toka Tumai, Auckland, New Zealand.
² Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Allied Health, Monash University, Clayton, VIC, Australia.
³ Department of Podiatry, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92 006, Auckland, 1142, New Zealand.
⁴ Active Living and Rehabilitation, Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
⁵ Department of Renal Medicine, Te Toka Tumai, Auckland, New Zealand.
⁶ School of Medicine, University of Auckland, Auckland, New Zealand.
⁷ Department of Podiatry, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92 006, Auckland, 1142, New Zealand. matthew.carroll@aut.ac.nz.
⁸ Active Living and Rehabilitation, Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand. matthew.carroll@aut.ac.nz.

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.

Keywords: Diabetes mellitus; End-stage renal disease; Haemodialysis; Toe systolic blood pressure; Toe-brachial index.

MeSH terms

Diabetes Mellitus*
Humans
Kidney Failure, Chronic* / therapy
Lower Extremity
Peripheral Arterial Disease*
Pilot Projects
Renal Dialysis
Toes