Evaluation of Peripheral Artery Occlusive Disease in Hemodialysis：Clinical Factors and Therapy

• Main Authors: Szu-Chia Chen, 陳思嘉
• Other Authors: Jer-Ming Chang
• Format: Others
• Language: en_US
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/w29ag2

博士 === 高雄醫學大學 === 臨床醫學研究所 === 106 === In Taiwan, the end-stage renal disease (ESRD) incidence is about 384 people per million population, which means that every million people there are 384 new cases of renal replacement therapy occur. The ESRD prevalence is about every hundred million population of 2288 people, which means that each one million population of 2288 people receiving renal replacement therapy. Regardless of incidence or prevalence in the United States kidney data entry system ranking, whcih are highest in the world, ranking first in the world (USRDS, 2010). Kidney disease is one of the most serious diseases in Taiwan. Peripheral arterial occlusive disease (PAOD) is atherosclerosis of the arteries below the aortic arch. As the course of the disease progresses, arterial diameter becomes narrower, affecting blood perfusion, resulting in ischemic symptoms of lower extremities. The studies found that the prevalence of PAOD is 4.3% in general population, and up to 23% in ESRD population. Therefore, the prevalence of PAOD is higher in ESRD than in general population. The studies also noted that higher morbidity and mortality rates in ESRD population combined with PAOD. Thus, the early decision in determining whether medical decision-making is more aggressive in assessing PAOD in patients with ESRD. In addition, autonomic dysfunction is one of uremic neuropathy, and most in patients with ESRD. Clinical autonomic neuropathy is mainly due to pressure receptors with abnormal blood pressure control function. Many ESRD patients have left ventricular hypertrophy, ischemic heart disease, hypertension and anemia, which are related to autonomic nervous function. The autonomic nervous system is affected by the situation in patients withESRD. Nearly two decades have evidence that there is a very important association between the autonomic nervous system and cardiovascular mortality. Heart rate variability (HRV) has been shown to be a powerful and independent predictor of post-myocardial mortality in the late 1980s. Previous studies have shown that HRV is an effective tool for adequately assessing cardiac autonomic regulation. HRV has been shown to be a noninvasive and effective tool for assessing cardiac autonomic nervous function. Autonomic neuropathy in patients with chronic renal failure can be assessed by a reduction in HRV. Patients with ESRD have a higher incidence of cardiovascular disease morbidity and mortality than the general population. Extensive vascular calcification, which is unique to patients with ESRD, is thought to be the leading cause of cardiovascular disease. Vascular calcification can be seen in the vascular intima and media, the mechanism has not yet been fully understood. Currently, there are several methods, including abdominal X-ray radiography, thoracic X-ray aortic arch calcification, carotid wall thickness measurement, and cardiac ultrasonography, sonic wave detection of calcification of the aortic valve, arterial wave velocity measurement, rapid three-dimensional navigation CT scan to assess vascular calcification index. The level of the index is also used to predict the probability of coronary artery disease. Therefore, based on the study group of hemodialysis patients, we want to explore (a), the association between PAOD and HRV, related to autonomic dysfunction, and HRV on clinical outcomes in hemodialysis patients; (B) the association between aortic arch calcification, from thoracic X-ray measurement, with arterial stiffness, and to see the prognosis of aortic arch calcification on clinical outcomes in hemodialysis patients; (c), The decline in ankle-brachial index (ABI) may be an important indicator of PAOD outcome. This study is to look at 6 years of hemodialysis patients ABI decline in the relevance and study of ABI decline related factors; (d), and finally explore the effect of far infrared ray therapy on PAOD in hemodialysis patients.