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Are Toe Systolic Blood Pressures and Toe Brachial Pressure Index Important for Persons With Kidney Failure With Replacement Therapy?

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Thesis(1.67 MB)

Date

2024

Authors

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Carroll, Matthew

Item type

Thesis

Degree name

Master of Philosophy

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Publisher

Auckland University of Technology

Abstract

Introduction Podiatrists attend dialysis centres to provide wound care and high-risk foot assessment, including peripheral vascular assessment. Persons with kidney failure with replacement therapy (KFRT) have a higher prevalence of peripheral arterial disease (PAD) and medial arterial calcification and are at higher risk of subsequent complications. Therefore, we must understand how toe systolic blood pressure (TSBP) and toe brachial pressure index (TBPI) are utilised in these populations and how the test performs. Objectives This thesis reports the results of two studies. The first study was a scoping review that identified the current literature on TSBP and TBPI for persons with kidney failure receiving haemodialysis (HD). The second study was a pilot study that aimed to determine the variability of TSBP and TBPI during HD in persons with kidney failure and whether any observed variability differed between persons with and without diabetes. Finally, future research directions based on the thesis findings are presented. Methods The scoping review (Study 1) included a systematic search of electronic databases to identify studies on persons with kidney failure on dialysis with reported TSBP or TBPI values. The pilot study (Study 2) involved the measurement of TSBP and TBPI before HD (timepoint 1), one hour into HD (timepoint 2), and just before the conclusion of HD (timepoint 3). Linear mixed-effects models were undertaken to determine the variability in TSBP and TBPI across the three-time points and whether this variability differed between people with and without diabetes. Results The scoping review (Study 1, Chapter 3) describes 16 studies that reported TSBP and TBPI in persons with kidney failure who were undergoing dialysis, and there were only 1,989 participants. Studies had heterogeneous study aims, combined with variable methodology and measurement protocols, and utilised a range of diagnostic thresholds, limiting the studies' direct comparability. Participant ethnicity and socioeconomic status reporting were minimal, which is significant due to known disparities in outcomes between these cohorts. The pilot study (Chapter 4) found a significant reduction in TSBP during haemodialysis but no significant decrease in TBPI during the three time points for all 30 participants. Comparison between participants with and without diabetes showed no significant differences. Conclusions The studies included in this thesis have provided an increased understanding of the current literature, including TSBP and TBPI measurement in people with kidney failure receiving HD and the performance of these tests during dialysis, which has the potential to influence clinical practice. The results are clinically important due to the high prevalence of PAD, ulceration, and amputation within this population. The study outcomes highlight the incidence of poor outcomes related to PAD in this population. Future research requires larger studies, with increased reporting on significant measurement protocol variables, for more accurate prevalence and prognostic data. Additionally, further studies may examine the potential of podiatrists to assess for PAD and determine if this will result in modified PAD treatment protocols for this population, which may reduce ulceration, amputation, and related mortality.

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http://hdl.handle.net/10292/18048

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Masters Theses