G. Lin et al., PULSE OXYMETRY EVALUATION OF OXYGEN-SATURATION IN THE UPPER EXTREMITYWITH AN ARTERIOVENOUS-FISTULA BEFORE AND DURING HEMODIALYSIS, American journal of kidney diseases, 29(2), 1997, pp. 230-232
We noticed that some patients with arteriovenous (AV) fistula on chron
ic hemodialysis experience pain in the limb with the fistula a short t
ime after being connected to the dialysis machine. We postulated that
the pain is caused by relative ischemia and therefore performed this s
tudy to determine whether oxygen saturation (SaO(2)) of the extremitie
s with AV fistula decreases during hemodialysis. Seventy-two patients
with a side-to-side primary AV fistula were evaluated by pulse oxymetr
y, SaO(2) was measured before hemodialysis and 20 minutes after initia
tion of dialysis. The contralateral arm served as a control, In 48 pat
ients, SaO(2) difference between the arms of each patient before hemod
ialysis was less than 4%. SaO(2) values of this group of patients did
not change significantly 20 minutes after initiation of dialysis. In 2
4 patients, SaO(2) differences between the hands of each patient befor
e hemodialysis were 4% or more, In this group of patients, SaO(2) valu
es of the hands with the AV fistula decreased significantly 20 minutes
after hemodialysis from a mean of 90.85 +/- 2.84% to 81.60 +/- 3.94 (
P < 0.001). SaO(2) remained unchanged in the contralateral arm. Nine p
atients in this group complained of pain and change in sensation in th
e arm with the fistula during hemodialysis. One patient complained of
severe pain in the arm with the fistula before hemodialysis, and SaO(2
) was unmeasurable. We conclude that, in some patients, SaO(2) of the
arm with the AV fistula decreases only during hemodialysis, This pheno
menon may be symptomatic, A predialysis SaO(2) difference of 4% or mor
e between the arms predicts decreased SaO(2) of the arm with the AV fi
stula during hemodialysis. (C) 1997 by the National Kidney Foundation,
Inc.