Dialysis therapy and its complications
Evgeniya Bublik1, Gagik Galstyan1, Galina Melnichenko1, Victor Safonov1, Euginy Shutov1, Pavel Filipcev1 & Oleg Udovichenko1
Aim: To study prevalence of foot complications in patients on dialysis therapy and evaluate the role the haemodynamic changes during dialysis procedure in development of foot problems.
Methods: 109 dialysis patients, mean age 49 years. 60 of them had diabetes mellitus (DM): 29 on haemodialysis (HD), 31 on peritoneal dialysis (PD). Non-diabetic patients (NDM): 24 HD, 25 PD.
Vascular status: doppler, photoplethysmography. Polyneuropathy: NDS. Monitoring of BP: during and after dialysis (follow-up period 14 months).
Results: Peripheral vascular disease (PVD) was associated with DM (16 DM vs. 1 NDM). Polyneuropathy: 51 DM, and in 7 NDM.
Ulcers were diagnosed only in DM patients (prevalence 25%). The number of patients with diabetic ulcers was increased after starting dialysis therapy (from 4 to 12) and it was due to increasing neuroischemic ulcers (from 0 to 8, P=0,016).
Transient intra- and postdialysis hypotension (TH) was determined in 15 HD, 5 PD. This group had significant fall of pressure in toe arteries during TH. Neuroischemic ulcers were frequently diagnosed in the group with PVD and HD, than with PVD and without HD; P=0,001.
Conclusions: Diabetic patients on dialysis therapy have high risk of neuroischemic ulcers. TH can intensify PVD and provoke neuroischemic ulcers.