Periferna arterijska bolest u bolesnika liječenih hemodijalizom

Ivica Horvatić, Alen Andrović, Ivana Bedalov Crnković, Ivana Delonga, Sonja Dits, Slava Doko, Ivan Durlen, Željka Grđan, Ivančica Hršak, Dijana Knežević Strinavić, Iva Papac Bebek, Ana Šavuk, Boris Kudumija, Draško Pavlović

Cilj: Ispitati pojavnost znakova ishemijske periferne arterijske bolesti (PAB), ulkusa nogu (UN) i amputacija nogu (AN) u bolesnika liječenih kroničnom intermitentnom hemodijalizom (HD) te njihovu povezanost s drugim kliničkim i laboratorijskim parametrima. Metode: U presječno istraživanje, provedeno od siječnja do svibnja 2023. godine, uključeno je 329 bolesnika iz 5 HD centara. Osim anamneze, pregleda dokumentacije te kliničkog pregleda (posebice pulzacija), praćeni su i zadnji laboratorijski nalazi bolesnika određivani u rutinskoj kliničkoj praksi. Za ispitivanje neovisnih rizičnih čimbenika za UN te AN korištena je multivarijatna logistička regresija. Rezultati: Uključeno je 202 muškarca (61,4%), 119 bolesnika s dijabetesom (36,2%), medijana HD liječenja 40 mjeseci. PAB nogu imalo je 98 (27,8%) bolesnika, UN 42 (12,8%), a AN 40 (12,2%) bolesnika. UN bolesnici imali su češće PAB, dijabetes, ishemijsku srčanu bolest, češće su bili pušači, češće su imali odsutne ili oslabljene pulzacije na svim lokalizacijama nogu te češće amputacije i hipoalbuminemiju. AN bolesnici češće su imali PAB, dijabetes, ulkuse nogu, češće su bili pušači i imali odsutne ili oslabljene pulzacije na svim lokalizacijama nogu i hipoalbuminemiju te su bili značajno mlađi i viši. U multivarijatnoj logističkoj regresiji kao nezavisni čimbenici rizika za UN nađeni su: PAB, dijabetes, duži HD staž i hipoalbuminemija. Nezavisni rizični čimbenici za AN bili su: PAB, UN, dijabetes, pušenje, mlađa dob i hipoalbuminemija. Zaključak: učestalost znakova PAB-a veća je u HD bolesnika u usporedbi s općom populacijom, a dijabetes, pušenje i dužina liječenja HD-om dodatni su rizični čimbenici. Potrebna su prospektivna istraživanja te kliničko praćenje statusa nogu u ovih bolesnika radi sprječavanja komplikacija.

Objective: To explore the prevalence of leg ulcers (LU) and non-traumatic lower extremity amputations (LEA) as signs of ischemic peripheral arterial disease (PAD) in patients treated by chronic intermittent hemodialysis (HD) and to examine their correlation with other clinical and laboratory parameters. Patients and methods: Three hundred thirty-nine patients from five HD centers were included in this cross-sectional study conducted between January and May of 2023. Patient clinical history, past documentation and thorough clinical examination (especially peripheral pulsations), as well as last routine laboratory findings were considered. Multivariate logistic regression analysis was used to determine the risk factors for LU and LEA. Results: Two hundred two men (61.4%), 119 diabetic patients (36.2%), with median HD treatment duration of 40 months were included. PAD was found in 98 (27.8%), LU in 42 (12.8%) and LEA in 40 (12.2%) patients. LU patients had more often PAD, diabetes, coronary artery disease, absent or diminished pulsations on all lower extremity locations and hypoalbuminemia and were more often smokers. LEA patients had more often PAD, diabetes, LU, absent or diminished pulsations on all lower extremity locations and hypoalbuminemia and were younger, taller and more often smokers. In multivariate logistic regression risk factors associated with LU, PAD, diabetes, longer HD duration and hypoalbuminemia were found. As risk factors for LEA, PAD, LU, diabetes, smoking, younger age and hypoalbuminemia
were found. Conclusion: The prevalence of PAD in HD patients is higher compared to the general population, and diabetes, smoking and HD vintage are additional risk factors. Larger, prospective studies, as well as frequent clinical examinations are needed to prevent further morbidity and mortality.