Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China.
Perit Dial Int. 2003 Dec;23 Suppl 2:S134-8.
We studied the effectiveness of a screening program for peripheral vascular disease (PVD) carried out by trained renal nurses in patients with and without diabetes on continuous ambulatory peritoneal dialysis (CAPD).
We recruited 30 stable diabetic and 30 stable non diabetic CAPD patients into this cross-sectional study. Trained renal nurses measured the patients' ankle-to-brachial systolic pressure index (ABI) using a Doppler ultrasound machine and their foot vibration perception (VPT) using a biothesiometer, and administered a questionnaire on foot symptoms. An ABI < 1.0 was regarded as abnormal and suggestive of the presence of PVD. An ABI < 0.7 or > 1.3 was regarded as severely abnormal. Findings for VPT were classified as normal or abnormal. Patients were then followed for 1 year for any overt development of clinical PVD, leg complications, and other vascular complications and for clinical outcome.
The mean age of the patients was 63 +/- 9 years, and the ratio of men to women was 1:1.3. An abnormal ABI was seen in 22 patients (37%). The questionnaire detected clinical PVD symptoms in 3 patients. Abnormal ABI and VPT findings were more frequent in diabetic patients. After 12 months of follow-up, patients with an abnormal ABI (and particularly those with a severely abnormal ABI) were more likely to develop leg complications and any type of cardiovascular disease than were patients with a normal ABI. Foot vibration perception had no predictive value on subsequent development of leg complications. When risk factors including age, ABI, and VPT were analyzed by logistic regression, only ABI was a significant independent predictor of subsequent lower-limb vascular complications [odds ratio (OR): 21.0; 95% confidence interval (CI): 2.35 to 187.0; p = 0.00064]. The OR for moderately abnormal ABI was 13.0 (95% CI: 1.015 to 166.3); for severely abnormal ABI, it was 27.4 (95% CI: 2.35 to 187.0, p = 0.0045).
Measurement of ABI by Doppler ultrasound is a useful and effective screening test for PVD in CAPD patients. In this study, VPT was not shown to be predicative of future leg complications, indicating that peripheral neuropathy plays a less important role in the development of such complications. Our results proved that trained renal nurses can play an active role in detecting foot problems in renal patients by ABI measurement.
我们研究了在接受持续非卧床腹膜透析（CAPD）的患者中，由经过培训的肾护士进行的外周血管疾病（PVD）筛查计划的效果，这些患者包括糖尿病患者和非糖尿病患者。
我们将 30 名稳定的糖尿病 CAPD 患者和 30 名稳定的非糖尿病 CAPD 患者纳入这项横断面研究。经过培训的肾护士使用多普勒超声机测量患者的踝肱收缩压指数（ABI），使用生物感觉计测量患者的足部振动感觉（VPT），并进行足部症状问卷。ABI＜1.0 被视为异常，并提示存在 PVD。ABI＜0.7 或＞1.3 被视为严重异常。VPT 结果被分类为正常或异常。然后，对患者进行为期 1 年的随访，以观察任何明显的临床 PVD、腿部并发症和其他血管并发症的发生，并观察临床结果。
患者的平均年龄为 63±9 岁，男女比例为 1:1.3。22 名患者（37%）的 ABI 异常。问卷检测到 3 名患者有临床 PVD 症状。ABI 和 VPT 异常在糖尿病患者中更为常见。在 12 个月的随访中，ABI 异常的患者（特别是 ABI 严重异常的患者）比 ABI 正常的患者更有可能发生腿部并发症和任何类型的心血管疾病。VPT 对随后发生腿部并发症没有预测价值。当通过逻辑回归分析包括年龄、ABI 和 VPT 在内的危险因素时，只有 ABI 是随后下肢血管并发症的显著独立预测因子[比值比（OR）：21.0；95%置信区间（CI）：2.35 至 187.0；p=0.00064]。中度异常 ABI 的 OR 为 13.0（95%CI：1.015 至 166.3）；严重异常 ABI 的 OR 为 27.4（95%CI：2.35 至 187.0，p=0.0045）。
多普勒超声测量 ABI 是一种有用且有效的 CAPD 患者 PVD 筛查试验。在这项研究中，VPT 并未显示出对未来腿部并发症的预测作用，这表明周围神经病变在这些并发症的发展中作用较小。我们的结果证明，经过培训的肾护士可以通过 ABI 测量在检测肾脏患者的足部问题方面发挥积极作用。
