Análisis de los factores influyentes en la prevalencia de las úlceras de pie en pacientes en hemodiálisis

Abstract

Introduction: Patients on renal replacement therapy with haemodialysis therapy are at high risk of suffering foot ulcer. This is due to the large number of associated risk factors.
Objective: The main goal of this study is to determine the prevalence of foot ulcers in patients who are being treated with haemodialysis therapy at San Rafael Hospital, A Coruña.
The secondary aim is to analyze the risk factors associated to foot ulcers.
Methods: A cross-sectional descriptive study is performed, including 131 patients suffering from chronic kidney disease. All these patients meet the inclusion criteria. Presence or absence of foot ulcers has been considered the main variable in this paper.
A vascular examination is performed following the procedure of inspect, palpate and registration of doppler sound of pedis and posterior tibial artery. Furthermore, an ankle-brachial index (ABI) is calculated.
A neurological examination is also performed. A monofilament is used to test protective sensation while a tuning fork is used to test deep sensitivity.
Results: 10,7% of the patients studied suffer from active ulcer on the foot. We unsuccessfully attempted to palpate a pulse in the pedis artery in 43,5% of patients. The attempt to palpate a pulse in the posterior tibial artery was also unsuccessful in 60% of patients. 25% of patients were found an ankle-brachial index (ABI) less than 0,90 and a 13, 5% has noncompressible arteries.
49,9% of the patients under study show alteration of deep sensation and a 44,3% show alteration of protective sensation.
Conclusion: The primary prevention through standardized protocols of the foot examination in the haemodialysis units will be able to reduce the chances of ulceration that can endanger patients’ quality of life.
A vascular, neurological and podiatric disorders examination must be done systematically, including patients with and without diabetes mellitus.