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.

Keywords

peripheral arterial disease screening end-stage renal disease pole test

Get full access to this article

View all access options for this article.

References

Diehm

Schuster

Allenberg

, et al. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis. 2004;172:95-105.

Arroyo

Betriu

Valls

, et al; Investigators from the NEFRONA Study. Factors influencing pathological ankle-brachial index values along the chronic kidney disease spectrum: the NEFRONA study. Nephrol Dial Transplant. 2017;32:513-520.

Vriens

D’Abate

Ozdemir

, et al. Clinical examination and non-invasive screening tests in the diagnosis of peripheral artery disease in people with diabetes-related foot ulceration. Diabet Med. 2018; 35:895-902.

Garimella

Hirsch

. Peripheral artery disease and chronic kidney disease: clinical synergy to improve outcomes. Adv Chronic Kidney Dis. 2014;21:460-471.

Writing Committee Members; Gerhard-Herman

Gornik

, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Vasc Med. 2017;22:Np1-Np43.

AbuRahma

Adams

AbuRahma

, et al. Critical analysis and limitations of resting ankle-brachial index in the diagnosis of symptomatic peripheral arterial disease patients and the role of diabetes and chronic kidney disease. J Vasc Surg. 2020;71:937-945.

Katz

De Boer

, et al. Association of chronic kidney disease with the spectrum of ankle brachial index the CHS (Cardiovascular Health Study). J Am Coll Cardiol. 2009;54:1176-1184.

Hwang

. Doppler ultrasonography of the lower extremity arteries: anatomy and scanning guidelines. Ultrasonography. 2017;36:111-119.

Hoyer

Sandermann

Petersen

. Randomised diagnostic accuracy study of a fully automated portable device for diagnosing peripheral arterial disease by measuring the toe-brachial index. Eur J Vasc Endovasc Surg. 2013;45:57-64.

10.

Park

Choi

Yang

. Utility of Toe-Brachial Index for diagnosis of peripheral artery disease. Arch Plast Surg. 2012;39:227-231.

11.

Smith

Shearman

Simms

Gwynn

. Falsely elevated ankle pressures in severe leg ischaemia: the pole test—an alternative approach. Eur J Vasc Surg. 1994;8:408-412.

12.

Pahlsson

Wahlberg

Olofsson

Swedenborg

. The toe pole test for evaluation of arterial insufficiency in diabetic patients. Eur J Vasc Endovasc Surg. 1999;18:133-137.

13.

Paraskevas

Ayari

Malikov

, et al. “Pole test” measurements in critical leg ischaemia. Eur J Vasc Endovasc Surg. 2006;31:253-257.

14.

Paraskevas

Koupidis

Tzovaras

Nikolaou

Mikhailidis

. Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures. Int Urol Nephrol. 2011;43:143-145.

15.

Curry

Krist

Owens

, et al. Screening for peripheral artery disease and cardiovascular disease risk assessment with the Ankle-Brachial Index: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320:177-183.

16.

Leskinen

Salenius

Lehtimaki

Huhtala

Saha

. The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics. Am J Kidney Dis. 2002;40:472-479.

17.

Ogata

Kumata-Maeta

Shishido

, et al. Detection of peripheral artery disease by duplex ultrasonography among hemodialysis patients. Clin J Am Soc Nephrol. 2010;5:2199-2206.

18.

Wikstrom

Hansen

Johansson

Ahlstrom

Lind

. Lower extremity artery stenosis distribution in an unselected elderly population and its relation to a reduced Ankle-Brachial Index. J Vasc Surg. 2009;50:330-334.

19.

Tehan

Bray

Keech

Rounsley

Carruthers

Chuter

. Sensitivity and specificity of the Toe-Brachial Index for detecting peripheral arterial disease: initial findings. J Ultrasound Med. 2015;34:1737-1743.