Jornal Vascular Brasileiro
http://www.jvb.periodikos.com.br/article/doi/10.1590/1677-5449.202500361
Jornal Vascular Brasileiro
Original Article

Utilização de ultrassonografia point-of-care na análise de alterações arteriais em pessoas com doença renal crônica em hemodiálise: estudo transversal

Use of point-of-care ultrasound in the analysis of arterial abnormalities in people with chronic kidney disease on hemodialysis: a cross-sectional study

Adson Aragão de Araújo Santos; Hellen de Carvalho Lima; Beatriz Vitória Carvalho Lordêlo; Romero Henrique de Almeida Barbosa; Ana Luisa Silveira Vieira; Matheus Rodrigues Lopes; Adirlene Pontes de Oliveira Tenório

http://dx.doi.org/10.1590/1677-5449.202500361 J Vasc Bras, vol.25, e20250036, 2026
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Resumo

Contexto: Indivíduos com doença renal crônica (DRC) apresentam risco duas vezes maior de doença arterial periférica (DAP) e são mais suscetíveis a calcificação arterial. O diagnóstico das alterações arteriais envolve a combinação de avaliação clínica e testes não invasivos. O índice tornozelo-braquial (ITB) é um método de avaliação de alterações arteriais, preditivo de mortalidade, com bom custo-benefício. O método Doppler contínuo é considerado padrão-ouro para análise de ITB, pois proporciona maior precisão, e a ultrassonografia point-of-care (POCUS) permite obter essa medida à beira leito.

Objetivos: Analisar a prevalência de alterações arteriais em indivíduos em hemodiálise por meio da POCUS.

Métodos: Estudo transversal, analítico e observacional realizado com 85 pacientes em hemodiálise, por meio da aplicação de questionário clínico e sociodemográfico e cálculo do ITB. O desfecho do estudo consistiu na análise da presença de alterações arteriais por meio da mensuração do ITB por meio do método POCUS.

Resultados: Evidenciou-se prevalência de 24,7% e 22,4% de pacientes com ITB sugestivo de DAP e de calcificação arterial, respectivamente. Diabetes melito (p = 0,02) e idade avançada (p = 0,01) foram identificados como os principais fatores de risco para DAP.

Conclusões: A avaliação com auxílio da POCUS identificou prevalência de 24,7% para DAP e 22,4% para calcificação arterial entre os pacientes com DRC. Idade avançada e diagnóstico de diabetes melito foram os principais fatores de risco associados à DAP. Os dados indicam que a POCUS é uma abordagem inovadora para diagnosticar alterações arteriais à beira leito em pacientes em hemodiálise.

Palavras-chave

doença arterial periférica; ultrassonografia; doença renal crônica; índice tornozelo-braço; hemodiálise

Abstract

Background: Individuals with chronic kidney disease (CKD) have twice the risk of peripheral arterial disease (PAD) and are more susceptible to arterial calcification. Diagnosing arterial abnormalities involves a combination of clinical assessment and noninvasive tests. The ankle-brachial index (ABI) is a cost-effective method for assessing arterial abnormalities and predicting mortality. Continuous Doppler ultrasound is the gold standard for ABI assessment due to its greater accuracy, and pointof-care ultrasound (POCUS) enables bedside measurement of this index.

Objectives: To analyze the prevalence of arterial abnormalities in individuals undergoing hemodialysis using POCUS.

Methods: We conducted an observational, analytical, cross-sectional study of 85 patients on hemodialysis, using a clinical and sociodemographic questionnaire and calculating the ABI. The primary outcome was the analysis of the presence of arterial abnormalities through the measurement of ABI using the POCUS method.

Results: The prevalence of ABI results suggestive of PAD and arterial calcification was 24.7% and 22.4%, respectively. Diabetes mellitus (p = 0.02) and advanced age (p = 0.01) were identified as the main risk factors for PAD.

Conclusions: The POCUS-assisted assessment identified a prevalence of 24.7% for PAD and 22.4% for arterial calcification among patients with CKD. Advanced age and diabetes mellitus were the main risk factors associated with PAD. The data suggest that POCUS is an innovative approach for the bedside diagnosis of arterial abnormalities in patients on hemodialysis.

Keywords

peripheral arterial disease; ultrasonography; chronic kidney disease; ankle brachial index; hemodialysis

References

1 Hiatt WR, Armstrong EJ, Larson CJ, Brass EP. Pathogenesis of the limb manifestations and exercise limitations in peripheral artery disease. Circ Res. 2015;116(9):1527-39. https://doi.org/10.1161/CIRCRESAHA.116.303566. PMid:25908726.

2 Martín-Rubio I, Marín-García B, Romero-Velasco E, Thuissard-Vasallo IJ, Bautista-Hernández A, Abad-Pérez D. Oscillometric devices vs. arterial doppler in measuring ankle-brachial index for diagnosing peripheral artery disease. Clínica Medica. 2024;163(3):128-31. https://doi.org/10.1016/j.medcli.2024.02.003. PMid:38643026.

3 Caldeira M, Mina F. Doença arterial obstrutiva periférica em pessoas com diabetes. Rev Port Diabetes. 2017;12(3):107-11.

4 Tungsrirut N, Taptiang K, Charoenkarn K, Piyachon P, Srisittipoj P, Rerkasem K. Pole test and ankle-brachial index by using doppler ultrasound for peripheral arterial disease in end-stage renal disease patients. Int J Low Extrem Wounds. 2020;19(4):359-63. https://doi.org/10.1177/1534734620951528. PMid:32844689.

5 AbuRahma AF, Adams E, AbuRahma J, et al. Critical analysis and limitations of the resting ankle-brachial index in the diagnosis of patients with symptomatic peripheral arterial disease and the role of diabetes mellitus and chronic kidney disease. J Vasc Surg. 2020;71(3):937-45. https://doi.org/10.1016/j.jvs.2019.05.050. PMid:31471230.

6 Aday AW, Matsushita K. Epidemiology of peripheral artery disease and polyvascular disease. Circ Res. 2021;128(12):1818-32. https://doi.org/10.1161/CIRCRESAHA.121.318535. PMid:34110907.

7 Ikizler TA, Burrowes JD, Byham-Gray LD, et al. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis. 2020;76(3, Suppl 1):S1-107. https://doi.org/10.1053/j.ajkd.2020.05.006. PMid:32829751.

8 Yamada S, Nakano T. Role of chronic kidney disease-mineral and bone disorder in the pathogenesis of cardiovascular disease in CKD. J Atheroscler Thromb. 2023;30(8):835-50. https://doi.org/10.5551/jat.RV22006. PMid:37258233.

9 Ohtake T, Ishioka K, Honda K, et al. Impact of coronary artery calcification in hemodialysis patients: Risk factors and associations with prognosis. Hemodial Int. 2010;14(2):218-25. https://doi.org/10.1111/j.1542-4758.2009.00423.x. PMid:20345389.

10 ElSayed NA, McCoy RG, Aleppo G, et al. 12. Retinopathy, neuropathy, and foot care: standards of care in diabetes—2025. Diabetes Care. 2025;48(1, Suppl 1):S252-65. https://doi.org/10.2337/dc25-S012. PMid:39651973.

11 Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(24):e1313-410. https://doi.org/10.1161/CIR.0000000000001251. PMid:38743805.

12 Golledge J, Moxon JV, Rowbotham S, Pinchbeck J, Quigley F, Jenkins J. High ankle brachial index predicts high risk of cardiovascular events amongst people with peripheral artery disease. PLoS One. 2020;15(11):e0242228. https://doi.org/10.1371/journal.pone.0242228. PMid:33180875.

13 Xu D, Li J, Zou L, et al. Sensitivity and specificity of the ankle—brachial index to diagnose peripheral artery disease: a structured review. Vasc Med. 2010;15(5):361-9. https://doi.org/10.1177/1358863X10378376. PMid:20926495.

14 Eid MA, Mehta KS, Goodney PP. Epidemiology of peripheral artery disease. Semin Vasc Surg. 2021;34(1):38-46. https://doi.org/10.1053/j.semvascsurg.2021.02.005. PMid:33757634.

15 Ogata H, Kumata-Maeta C, Shishido K, et al. Detection of peripheral artery disease by duplex ultrasonography among hemodialysis patients. Clin J Am Soc Nephrol. 2010;5(12):2199-206. https://doi.org/10.2215/CJN.09451209. PMid:20798256.

16 Huang HL, Chang CH, Lo MT, Lin C. Diagnostic potential of combined photoplethysmography and ankle-brachial index in peripheral arterial disease: a duplex ultrasonography-based comparative study. J Am Heart Assoc. 2024;13(19):e034625. https://doi.org/10.1161/JAHA.124.034625. PMid:39344605.

17 Kollias A, Xilomenos A, Protogerou A, Dimakakos E, Stergiou GS. Automated determination of the ankle-brachial index using an oscillometric blood pressure monitor: validation vs. Doppler measurement and cardiovascular risk factor profile. Hypertens Res. 2011;34(7):825-30. https://doi.org/10.1038/hr.2011.53. PMid:21593742.

18 Buschmann EE, Li L, Brix M, et al. A novel computer-aided diagnostic approach for detecting peripheral arterial disease in patients with diabetes. PLoS One. 2018;13(6):e0199374. https://doi.org/10.1371/journal.pone.0199374. PMid:29928037.

19 Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126(24):2890-909. https://doi.org/10.1161/CIR.0b013e318276fbcb. PMid:23159553.

20 Normahani P, Poushpas S, Alaa M, et al. Diagnostic accuracy of point-of-care tests used to detect arterial disease in diabetes: Testing for Arterial Disease in Diabetes (TrEAD) study. Ann Surg. 2022;276(5):e605-12. https://doi.org/10.1097/SLA.0000000000004545. PMid:33630461.

21 Ichihashi S, Desormais I, Hashimoto T, Magne J, Kichikawa K, Aboyans V. Accuracy and reliability of the ankle brachial index measurement using a multicuff oscillometric device versus the Doppler method. Eur J Vasc Endovasc Surg. 2020;60(3):462-8. https://doi.org/10.1016/j.ejvs.2020.06.013. PMid:32763120.

22 Bastos M, Vieira ALS, Pazeli JMJ. Uso da ultrassonografia “point-of-care” na prática nefrológica: transpondo os limites do trato urinário. HU Revista. 2019;45(3):341-51. https://doi.org/10.34019/1982-8047.2019.v45.28745.

23 Fitridge R, Chuter V, Mills J, et al. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes mellitus and a foot ulcer. J Vasc Surg. 2023;78(5):1101-31. https://doi.org/10.1016/j.jvs.2023.07.020. PMid:37724985.

24 Dias SVM, Flumignan RLG, Carvas N Jr, Iared W. Accuracy of duplex ultrasound in peripheral artery disease: a systematic review and meta-analysis. J Vasc Bras. 2025;24:e20240033. https://doi.org/10.1590/1677-5449.202400332. PMid:39981417.

25 Drake A, Dreyer N, Hoffer M, Boniface K. Point-of-care ultrasound for evaluation of acute arterial pathology in the emergency department: a case series. Clin Pract Cases Emerg Med. 2022;6(1):1-7. https://doi.org/10.5811/cpcem.2021.11.54904. PMid:35226837.

26 Herraiz-Adillo Á, Cavero-Redondo I, Álvarez-Bueno C, Pozuelo-Carrascosa DP, Solera-Martínez M. The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: a systematic review and meta-analysis. Atherosclerosis. 2020;315:81-92. https://doi.org/10.1016/j.atherosclerosis.2020.09.026. PMid:33036766.

27 Miot HA. Tamanho da amostra em estudos clínicos e experimentais. J Vasc Bras. 2011;10(4):275-8. https://doi.org/10.1590/S1677-54492011000400001. PMid:30787944.

28 Arroyo D, Betriu A, Valls J, et al. Factors influencing pathological ankle-brachial index values along the chronic kidney disease spectrum: the NEFRONA study. Nephrol Dial Transplant. 2017;32(3):513-20. https://doi.org/10.1093/ndt/gfw039. PMid:27190385.

29 Instituto Brasileiro de Geografia e Estatística. Panorama das cidades brasileiras: Paulo Afonso/Bahia [Internet]. Rio de Janeiro; 2022 [citado 2024 nov 18]. https://cidades.ibge.gov.br/brasil/ba/paulo-afonso/panorama

30 Ramos MAA, Litchteneker K, Santana TC, Unser V. Doença arterial obstrutiva periférica em pacientes com insuficiência renal crônica dialítica na região de Toledo-Paraná: prevalência e fatores de risco. Rev Ciênc Méd Biol. 2022;21(2):232-7. https://doi.org/10.9771/cmbio.v21i2.45297.

31 Erzinger FL, Polimanti AC, Pinto DM, et al. Brazilian Society of Angiology and Vascular Surgery guidelines on peripheral artery disease. J Vasc Bras. 2024;23:e20230059. https://doi.org/10.1590/1677-5449.202300592. PMid:39493832.

32 Cáceres-Farfán L, Moreno-Loaiza M, Cubas WS. Ankle-brachial index: more than a diagnostic test? Arch Peru Cardiol Cir Cardiovasc. 2021;2(4):254-62. https://doi.org/10.47487/apcyccv.v2i4.168. PMid:37727667.

33 Huthart S, Oates C, Allen J, Fiaschi K, Sims AJ, Stansby G. Validation of a standardised duplex ultrasound classification system for the reporting and grading of peripheral arterial disease. Eur J Vasc Endovasc Surg. 2022;64(2-3):210-6. https://doi.org/10.1016/j.ejvs.2022.04.013. PMid:35472448.

34 Bastos MG, Novaes AKB, Pazeli JM Jr. Traditional and ultrasound physical examinations: a hybrid approach to improve clinical care. Rev Assoc Med Bras. 2018;64(5):474-80. https://doi.org/10.1590/1806-9282.64.05.474. PMid:30304149.

35 Berger JS, Newman JD. Overview of peripheral artery disease in patients with diabetes mellitus. Waltham: UptoDate; 2021.

36 Pichone A, Campos G, Leite M Jr, Gomes CP. High ankle-brachial index predicts cardiovascular events and mortality in hemodialysis patients with severe secondary hyperparathyroidism. J Bras Nefrol. 2021;43(4):478-85. https://doi.org/10.1590/2175-8239-jbn-2020-0218. PMid:33979425.

37 Hishida M, Imaizumi T, Menez S, et al. Additional prognostic value of toe-brachial index beyond ankle-brachial index in hemodialysis patients. BMC Nephrol. 2020;21(1):353. https://doi.org/10.1186/s12882-020-01991-7. PMid:32819299.

38 Bonato FOB, Karohl C, Canziani MEF. Diagnosis of vascular calcification related to mineral and bone metabolism disorders in chronic kidney disease. J Bras Nefrol. 2021;43(4, Suppl 1):628-31. https://doi.org/10.1590/2175-8239-jbn-2021-s104. PMid:34910796.

39 Tian L, Jaeger BC, Scialla JJ, et al. Progression of coronary artery calcification and risk of clinical events in CKD: the chronic renal insufficiency cohort study. Am J Kidney Dis. 2025;85(1):67-77.e1. https://doi.org/10.1053/j.ajkd.2024.06.018. PMid:39154888.

40 Hazique M, Surana A, Patel KN, et al. Abnormal Ankle-Brachial Index and risk of cardiovascular and all-cause mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Crit Pathw Cardiol. 2025;24(3):e0396. https://doi.org/10.1097/HPC.0000000000000396. PMid:40397761.
 

Submitted date:
02/19/2025

Accepted date:
03/27/2026

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