Dialysate conductivity is routinely used as a surrogate for dialysate sodium concentration. However, dialysis machine manufacturers apply different conductivity temperature correction coefficients. With the same conductivity in dialysis machines manufactured by different manufacturers, dialysate sodium may significantly differ. Also, electrolyte prescriptions are individualized (K, Ca, HCO3) and this is associated with another variation in dialysate sodium in the order of 1-5 mmol/L and both deviations are cumulative and chronic for each patient. Equivalence of the prescribed dialysate sodium and the concentration measured in it is not granted. Both variables differ and it is machine dependent! This paper analyses those variations from a technical point of view and suggests how to detect them and how to deal with or avoid them in clinical practice.
- MeSH
- dialýza ledvin MeSH
- dialyzační roztoky chemie MeSH
- elektrická vodivost MeSH
- lidé MeSH
- nevhodné předepisování MeSH
- sodík analýza normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Peripheral artery disease (PAD) represents a major complication in chronic kidney disease (CKD) patients, but its early diagnosis is still problematic. Traditionally, ankle-arm blood pressure index (API) determined by means of a simple hand-held unidimensional Doppler device has been used for noninvasive diagnosis of PAD, with a cutoff value of 0.9. However, in CKD patients, vascular disease includes not only atherosclerosis but also arteriosclerosis with high calcification score. There, the API method often fails. DEVELOPMENT OF THE METHOD: Based on complex examination of Doppler signals recorded at 4 main arteries of both lower extremities (a. femoralis, a. poplitea, a. dorsalis pedis, a. tibialis posterior) and their semiquantitative assessment, we introduced the Obliteration Index (OI) as a novel and simple tool allowing semiquantitative assessment of PAD in CKD patients: the signal from each artery is assessed in a 6-grade scale, with each grade represented by 5 points. The sum of points allocated to all arteries constitutes the final OI value, ranging from 0 (normal finding) up to 240 (most severe PAD). VERIFICATION OF THE METHOD: Comparison of the OI method with the conventional API examined in over 100 renal patients revealed superior OI sensitivity in detection of PAD in the early stage and low-grade vessel infliction where the API still remains within the normal range. OI can also be evaluated even when API is not measurable. Very good correspondence was found between the OI and angiography. CONCLUSIONS: The OI method has now been introduced into routine use in the authors' department. Based on over 1,500 OI evaluations performed so far, it can be recommended as a simple, noninvasive, bedside tool for diagnosis of early as well as advanced PAD.
- MeSH
- angiografie MeSH
- arteria femoralis patofyziologie MeSH
- arteria poplitea patofyziologie MeSH
- arteriae tibiales patofyziologie MeSH
- bérec krevní zásobení MeSH
- chronická nemoc MeSH
- krevní tlak MeSH
- lidé MeSH
- nemoci ledvin komplikace patofyziologie MeSH
- onemocnění periferních cév diagnóza patofyziologie MeSH
- ultrazvuk MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
