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Feasibility of utilizing near-infrared spectroscopy and peripheral arterial tonometry to detect subclinical microvascular dysfunction in lower-limbs of patients with end-stage kidney disease
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- Author / Creator
- Bok, Ilhae
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Cardiovascular disease stands as the primary cause of death among the population with dialysis-dependent end-stage kidney disease (ESKD). A significant portion of the ESKD population is diagnosed with peripheral arterial disease (PAD). The current clinical guidelines for PAD are considered insufficient for proper screening and management of individuals with ESKD. Microvascular dysfunction may precede the large vessel blockages characteristic of PAD and is a potential target for early detection and treatment. We assessed the feasibility (acceptability, interpretability, technical difficulty) of using near-infrared spectroscopy (NIRS) in the lower limb (tibialis anterior), and peripheral arterial tonometry (PAT) to assess microvascular function. A priori, feasibility was defined ≤ 10% of tests complicated by these domains. We also explored the reliability and validity of NIRS compared to the referent test of brachial hyperemic velocity-time integral (VTI). Fourteen individuals receiving hemodialysis (HD) and twenty-one healthy controls participated. Suprasystolic blood pressure (50mmHg above systolic blood pressure) was applied to induce arterial occlusions in the forearm and calf. The occlusion tests in the calves were terminated due to discomfort in four individuals in the HD group (i.e., 28%). Of the eleven individuals in the HD group who underwent NIRS tests, the data from two (i.e., 18%) were uninterpretable, while no data were missed due to technical issues. Therefore, within the current parameters, these procedures are not feasible in individuals with ESKD. In those with complete data in the HD group (N=9), NIRS parameters had moderate to high intraclass correlations, showing good test-retest reliability. Correlation analysis between brachial VTI and calf muscle oxygen consumption (mVO2%) measured by NIRS, and PAT was r=-0.43, p=0.21 and r=0.11, p=0.79 in the HD group, and r=0.19, p=0.41 and r=0.25, p=0.44 in the control group. The findings from this study provide information for determining the sample size required for future diagnostic studies to develop more sensitive and accurate tests for vascular function in the population with ESKD.
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- Graduation date
- Fall 2023
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- Type of Item
- Thesis
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- Degree
- Master of Science
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- License
- This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.