P1094PULSE AMPLITUDE OF THE TOE MEASURED WITH A PORTABLE LASER DOPPLER FLOW METER IS USEFUL FOR SCREENING OF DIALYSIS PATIENTS FOR PERIPHERAL ARTERIAL DISEASE
Authors: Saito Makoto , Jingu Hiroomi , Oyama Yusuke , Tanaka Toshiyuki , Shiono Akihiko , Machida Masami 
Published: June 2020

Abstract

Background and Aims
Peripheral arterial disease (PAD) occurs at a high frequency in hemodialysis (HD) patients and is known to be associated with poor outcomes. Measurement of the ankle-brachial blood pressure index (ABI) or toe brachial index (TBI) has been used for screening, diagnosis and severity determination of PAD. However, the procedures for measurement of these indices are complicated and the measurements cannot be performed during dialysis sessions. The purpose of the present study was to clarify the ability of the toe blood flow and pulse amplitude measured with a portable laser Doppler flow meter (LDF) to detect PAD in dialysis patients, in comparison with the diagnostic abilities of ABI and TBI.

Methods
Fourteen patients on maintenance HD participated in this study. The mean age was 65.2 years old and the mean duration of HD was 9.1 years. We measured the ABI and TBI before HD, and the blood flow and pulse amplitude on the ventral side of the first toe with a portable LDF (pocket LDF®, JMS Co., Ltd., Tokyo, Japan) during the HD session on the same day. The correlations between the blood flow / pulse amplitude in the toe and the ABI / TBI were investigated. The sensitivity and specificity of the blood flow and pulse amplitude in the toe for PAD detection were determined by a receiver operating characteristic curve analysis. Statistical analysis was performed using the Fisher’s exact test. A p value of &lt;5% was considered to indicate a significant difference.

Results and Discussion
No significant correlation was found between the blood flow and the pulse amplitude in the toe (p = 0.454). The blood flow was not correlated with either the ABI or the TBI (p = 0.286, p = 0.115, respectively). However, the pulse amplitude showed significant correlations with both the ABI and TBI (p &lt; 0.001, p &lt; 0.05). When we used the general reference cutoff values for ABI and TBI of 0.9 and 0.6, respectively, the sensitivity and specificity of ABI for the detection of PAD were 0.75 and 0.75, respectively, and those of TBI were 1.0 and 0.75, respectively. On the other hand, the sensitivity and specificity of blood flow in the toe were 0.50 and 1.0, respectively, when the cutoff value was set at 23.8 mL/min. The sensitivity and specificity of the pulse amplitude were 0.75 and 1.0, respectively, when the cutoff value was set at 7.6 mL/min. These results indicate that the pulse amplitude in the toe showed a high diagnostic ability, like ABI and TBI, for the detection of PAD. Although our results in this study were obtained from a small sample size and further investigation is warranted, the pulse amplitude measured with the portable LDF was correlated well with both the ABI and TBI, and its sensitivity and specificity for the detection of PAD were also high, indicating the high diagnostic ability of the pulse amplitude for PAD. As compared to the measurement of ABI or TBI, the pulse amplitude in the toe can be easily measured with a portable LDF, even during a dialysis session. Thus, we believe that the use of a portable LDF might be of great benefit as a screening tool for PAD.

Conclusion
The pulse amplitude in the toe measured with a portable LDF may have the potential to become a novel easily measurable index in the screening of dialysis patients for PAD.