title: Perfusion pressures and distal oxygenation in individuals with diabetes undergoing chronic hemodialysis.
abstract: BACKGROUND
  The number of diabetic patients worldwide was estimated to be approximately 285 million in 2010. Approximately 5% of all diabetic patients have foot ulcers, often preceded by neuropathy and delayed healing resulting from peripheral vascular disease which leads to increased risk of infection. Additionally, there is a concern that blood flow to the feet may be reduced in patients with diabetes, which may be further compounded by changes in lower extremity perfusion pressure during hemodialysis. Current laser Doppler technology provides the opportunity to identify changes in vascularityin a non-invasive fashion.
  
  
  METHODS
  A prospective, parallel-arm, comparison, pilot study was conducted. A total of 15 patients were enrolled, ten of whom had a documented history of diabetes. All patients required hemodialysis. Peripheral perfusion and oxygenation measurements were obtained before, midway and at the conclusion of three separate dialysis sessions within a 3-week interval for each subject.
  
  
  RESULTS
  Preliminary results indicate a significant reduction in toe pressure during and after hemodialysis in the diabetic patient group compared to the non-diabetic group. Significant differences were not found in skin perfusion measurements or in the oxygenation measurements at any time in diabetic and nondiabetic patients undergoing hemodialysis.
  
  
  CONCLUSIONS
  Preliminary results suggest hemodialysis may significantly affect pressure of the lower extremities in diabetic patients. Trends from these data indicate the need to further investigate the effect of hemodialysis on techniques used to heal wounds and ulcers in patients with diabetes.
authors.affiliation: Department of Orthopaedic Surgery, Nephrology Section, Akron General Medical Center, Akron, OH 44307, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Kay
authors.forename: Susan
authors.initials: S
authors.lastname: Ray
authors.forename: Nairmeen Awad
authors.initials: NA
authors.lastname: Haller
authors.forename: Michael
authors.initials: M
authors.lastname: Hewit
mesh_terms: D000368:Aged; D017719:Diabetic Foot / Q000097:blood* / Q000503:physiopathology*; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D016014:Linear Models; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010865:Pilot Projects; D011312:Pressure; D011446:Prospective Studies; D006435:Renal Dialysis; D014945:Wound Healing / Q000502:physiology
chemical_list: D010100:Oxygen