What does this research mean for the field?

Evaluation of periflux blood flow decreasing velocity (PDV) using a laser-Doppler blood flow meter is an effective, non-invasive method for assessing autonomic dysfunction in hemodialysis patients that is comparable to standard approaches. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 28, 2023Open Access

The cardiovascular mononeuropathy in Hemodialysis Patients analysed by a combination with reactivity tests to noninvasively evaluate skin sympathetic nerve activity and skin microvascular function by (LDF)

Structured PICO

Does non-invasive monitoring of periflux blood flow decreasing velocity (PDV) using laser-Doppler flowmetry correlate with traditional measures of autonomic dysfunction in stable hemodialysis patients?

Population

74 participants (34 stable hemodialysis patients without diabetes, 40 healthy volunteers). Hemodialysis patients had been receiving stable therapy for >3 months with no hypotensive episodes in the previous 3 months.

Intervention

Non-invasive continuous monitoring method (NICOMM) using a laser-Doppler blood flowmeter (LDF) to measure periflux blood flow decreasing velocity (PDV) during the Valsalva manoeuvre. A nested sub-study administered sarpogrelate hydrochloride 300 mg (100 mg three times daily) orally.

Comparator

Healthy controls (for the observational LDF evaluation) and matching placebo capsules (for the sarpogrelate sub-study).

Outcome

Periflux blood flow decreasing velocity (PDV) measured by laser-Doppler flowmeter.surrogate

Laser-Doppler flowmetry during the Valsalva manoeuvre provides a non-invasive, reliable measure of autonomic dysfunction in hemodialysis patients that correlates well with traditional markers like heart rate variability and ankle-brachial index.

Abstract

Aim: Although several patients with kidney disease have simultaneous dysfunction of the parasympathetic and sympathetic nervous systems, orthostatic hypotension during a hemodialysis (HD) procedure impacts not only the form of treatment but overall comfort of life for patients with HD. Despite a number of methods that are not invasive and have already been used to assess autonomous functioning, a system for monitoring malfunction throughout filtration of blood therapy which has yet to be discovered. Methods: Regarding the purpose of monitoring the autonomous function of stable 40 regular HD patients and 35 healthy controls, we examined the clinical application of the laser-Doppler blood flow meter (LDF). By detecting the periflux blood flow decreasing velocity (PDV) while combined with the Valsalva manoeuvre, the LDF device which was used for an autonomous test. We also looked at the relationship between PDV and traditional atherosclerosis testing. Results: The baseline PDV (5.30 ± 2.93), comparative to subjects who were in excellent condition (9.65 ± 7.10), was substantially decreased in the HD populace. Furthermore, we discovered a substantial connection between PDV and established parameters like heart rate fluctuation and ankle-brachial blood pressure indexing. Conclusion: Regarding assessing autonomous functioning in hemodialysis patients, evaluation of PDV by LDF is just as effective as the standard approach. The benefit from regular and recurring assessments of autonomous dysfunction is made possible by the device's ease.

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