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Association of Quantitative Sensory Testing With Ankle-Brachial Index and Brachial-Ankle Pulse Wave Velocity in Patients on Hemodialysis

摘要


BACKGROUND: Peripheral neuropathy is the most common neurological complication associated with uremia, and quantitative sensory testing (QST) is valuable in diagnosing small fiber neuropathy. However, no previous study has investigated whether there is an association between QST and peripheral artery disease (PAD) in patients undergoing hemodialysis (HD). Therefore, the aim of this study was to examine whether there is an association between QST and PAD, as assessed by the ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV), in patients undergoing HD, and to evaluate the major determinants of abnormal QST thresholds. METHODS: A total of 152 (78 men and 74 women) patients undergoing HD who underwent ABI and QST measurements were enrolled. PAD was defined as an ABI < 0.9 or baPWV > 1400 cm/sec in either leg, and an abnormal QST threshold was defined as a decreased cold threshold and increased warm threshold in the hands or feet. Multivariate forward logistic regression analysis was used to test the association between abnormal QST threshold and PAD. RESULTS: Multivariate analysis revealed that a baPWV > 1400 cm/sec (odds ratio [OR], 10.335; 95% confidence interval [CI], 2.001-53.379; P = 0.005) was independently associated with an abnormal warm threshold in the feet. Even after excluding patients with ABI < 0.9, baPWV > 1400 cm/s was still significantly associated with abnormal warm threshold in the feet (OR, 10.209; 95% CI, 1.697-64.406; P = 0.011). In addition, old age, diabetes, low body mass index, low total cholesterol, low hemoglobin, and high calcium-phosphorus product were also associated with an abnormal QST threshold. CONCLUSION: The baPWV > 1400 cm/sec was associated with an abnormal QST threshold in our patients undergoing HD. An early diagnosis of preclinical neuropathy in these patients is important to prevent or delay complications.

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