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Kidney Week

Abstract: TH-PO352

Severe but Not Mild Hand Ischemia Is Associated with Poorer Survival in Hemodialysis Patients

Session Information

  • Vascular Access - I
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Gerrickens, Michael, Maxima MC, Veldhoven, Netherlands
  • Yadav, Reshabh, Maxima MC, Veldhoven, Netherlands
  • Wouda, Rosanne, Zuyderland MC, Heerlen, Netherlands
  • Scheltinga, Marc, Maxima MC, Veldhoven, Netherlands
Background

Some hemodialysis (HD) patients develop hemodialysis access-induced distal ischemia (HAIDI) of the hand that is caused by loss of blood pressure along the heart-hand axis. Anecdotal data suggest that the presence of hand ischemia is associated with poorer patient survival. We hypothesized that patients with severe HAIDI have a worse survival compared to patients with mild or no HAIDI.

Methods

Two patient groups were studied between January 2006 and December 2018 in one Dutch hospital. A control group consisted of patients on stable HD without symptoms or signs of hand ischemia. The experimental group (HAIDI) reported pain and coldness in the dialysis hand in the presence of low digital brachial indices DBIs (normal >0.8, now <0.6). HAIDI patients were graded as mild (Grade I-IIa) or severe (IIb-IV) as suggested by a 2016 consensus meeting. Access flows (Qa) were obtained and potential factors associated with 4-year overall survival were calculated using standard statistical testing.

Results

Age and time on HD tended to be higher in controls (n=45, 24 males; age 73yrs ±12, HD 34months ±26) compared to the HAIDI group (n=49, 26 males; age 68yrs ±16, HD 23months ±28; 0.05<p<0.09). Controls displayed lower Qa and higher DBI (Qa: 1.2L/min ±0.1 vs 1.8L/min ±0.2; DBI 0.80 ±0.2 vs 0.34 ±0.03; both p≤0.001). Interestingly, both Qa and DBI were higher in mild HAIDI (n=26) compared to severe HAIDI (n=23; Qa: 2.4L/min ±0.2 vs 1.1L/min ±0.1; DBI 0.42 ±0.02 vs 0.26 ±0.05; both p=0.005). A total of 43 patients (47%) died during the 4-year follow-up. Overall 2 and 4-year survival were similar in controls and grade I-IIa HAIDI (2-year 79% ±5; 4-year 55% ±6) but lower in grade IIb-IV HAIDI (2-year 58% ±10; 4-year 34% ±10; p<0.028). Following correction for age (HR 1.04 [1.01 - 1.07]), presence of diabetes (HR 2.11 [1.13 - 3.04]) and cardiovascular disease (HR 2.74 [1.48 - 5.09]), low DBI displayed some predictive value for 4-year mortality (HR .99 [.98 - .99], p=0.05)

Conclusion

Severe hand ischemia is associated with poorer survival in HD-patients. Moreover, lower DBI-values have some predictive value for overall mortality, even when correcting for known risk factors.