Patients with severe hand ischemia due to an arteriovenous access experience more symptoms at rest than during a hemodialysis session

Abstract

Background:

Patients undergoing hemodialysis (HD) occasionally develop hand ischemia, known as hemodialysis access-induced distal ischemia (HAIDI), which is often first observed during a dialysis session. It is unknown if these patients also experience symptoms at rest. The aim of this study was to quantify hand ischemic symptoms during HD and on a day of rest in HAIDI patients and controls.

Methods:

This case-control study evaluated patients who were operated for minimal grade 2b HAIDI between 2004 and 2021 in a single center. Dialysis patients without HAIDI were recruited cross-sectionally in 2022 and served as controls. The primary outcome was the hand ischemic score, measured using a validated questionnaire (HIQ, Hand Ischemic Questionnaire), which assessed the severity (VAS, 0–10) and frequency (VAS, 0–10) of ischemic symptoms during a HD session and at rest. Scores for pain, cramps, coldness and loss of sensibility each ranged from 0 (never any) to 100 points (always very severe). The total score of the HIQ ranged from 0 points to 400 points.

Results:

A total of 94 end-stage renal disease (ESRD) patients were studied (49 HAIDI patients, 45 controls). HIQ scores reported at rest by HAIDI patients were significantly higher compared to values during HD (rest 113 ± 11 vs HD 73 ± 11, p = 0.004). HIQ scores reported by control patients at rest were also significantly higher compared to values during HD (rest 46 ± 9, HD vs 34 ± 9, p = 0.030). Differences in scores at rest and during HD were significantly higher in HAIDI compared to controls (HAIDI Δ 40 ± 13 vs rest Δ 12 ± 8, p = 0.030) suggesting compromised collateral reserve in HAIDI.

Conclusions:

Patients with advanced stages of HAIDI experience more symptoms of hand ischemia at rest than during a hemodialysis session. These findings suggest a potential role for screening in a home setting.