Pole Test and Ankle-Brachial Index by Using Doppler Ultrasound for Peripheral Arterial Disease in End-Stage Renal Disease Patients

Abstract

Peripheral arterial disease (PAD) causes great disability in end-stage renal disease (ESRD). Pole test is a simplified test utilizing the basis of Doppler ultrasound invented to correct false elevation in ankle-brachial index (ABI) in diabetic patients with severe calcification of the tibial artery. However, the role of pole test in ESRD patients is still unclear. The aim of this study was to explore the sensitivity, specificity, and overall utility of pole tests in such patients. One hundred and four patients were recruited and examined with 3 tests: pole test, ABI, and toe-brachial index, the latter serving as the gold standard. Receiver operating characteristic analysis was performed using SPSS version 22.0. The sensitivity, specificity, and other diagnostic values of ABI and pole tests were calculated. There were 104 ESRD patients enrolled. Pole tests showed to have low probability to provide accurate results (area under the curve = 0.505, standard error = 0.042). Low sensitivity of ABI (34.96%) can be observed in ESRD patients. Specificity, positive predictive value, and negative predictive value of ABI in all cases were, respectively, 85.91%, 81.13%, and 43.26%. It is concluded that pole test accuracy seemed to be limited in ESRD patients. ABI was found to be confounded by medial arterial calcification, resulting in low sensitivity as well. The results of this study permit the observation that an optimal tool for screening peripheral arterial disease in ESRD patients remains to be discovered.

Role of Hemodynamic Assessment and Limitations in Ankle-Brachial Pressure Index, Toe- Brachial Pressure Index to Predict Wound Healing After Revascularization

“…This is a simple low tech method that could be used on the ward, especially on patients who are unable to tolerate the pressure of the cuff or those with MAC and false elevated ABPI. 23,24 Last but not least, tests that mimic the walking stress could be used to uncover mild disease. Some patients with PAD present with normal systolic pressures at rest.…”

Ultrasound: The Magic Wand for Wound Healers

“…Moreover, 2 studies provide original data. Tungsrirut et al 9 have examined the diagnostic performance of the ankle-brachial index and the pole test by Doppler ultrasound to detect peripheral arterial disease in patients with end-stage renal disease. Rerkasem et al 10 have compared findings with ankle-brachial index and carotid intima media thickness by ultrasound in patients with end-stage renal disease and those with human immunodeficiency virus (HIV) infection and indicate the potential value of intima-media thickness measurements in the latter cohort as well.…”