Abstract:

Ｏｂｊｅｃｔｉｖｅ：To discuss the value of the application of photoplethysmography(PPG) for the diagnosis of hemodialysis accessinduced distal ischemia(HAIDI).
Ｍｅｔｈｏｄｏｌｏｇｙ：Sixty nine  patients with ESRD who were referred to our nephrology department for arteriovenous fistula creation with endtoside anastomosis between June 2016 and december 2016 were included in the prospective cohort study.Patients were asked to take PPG test in peroperative（0～48 h）,one day(12～24 h),one month and 3 months after operative,whose measurement indicators included basal digital pressure(BDP),change in digital pressure with access compression(CDP),digital to contralateral brachial index(DBI).And to respond to hand ischemia questionnaire(HIQ) in 1 and 3 month after operation.In addition,groups were divided into HAIDI or no HAIDI according to whether patients with HAIDI symptoms.
Ｒｅｓｕｌｔｓ：Sixty two patients underwent followup study,including 15 cases (217%) developed HAIDI,However,the ischemic syndrome in 5 patients had relieved  3 month after operation.BDP and DBI in HAIDI group were significantly lower than the control group in each time after operation (P<0001),CDP in HAIDI group were significantly higher than the control group in 1 and 3 month after operation.BDP and DBI in each time after operation were significantly lower than preoperation in both groups(P<001),In HAIDI group,DBI decreased from 09 to 051,and recovered slightly to 059 in 3 month after operative.However,DBI decreased from 094 to 072 in the control group,and recovered slightly to 083 in 3 month after operative.A drop of DBI in HAIDI group was significantly greater than the control group.HIQ scores in HAIDI group was significantly higher than the control group in 1 and 3 month after operative（10733±5496 vs 574±1175,and 10400±3924 vs 532±1018,P＜0001).
Ｃｏｎｃｌｕｓｉｏｎ：
PPG can be used to detect HAIDI,the diagnostic accuracy of BDP and DBI was higher than CDP,The diagnostic thresholds of HAIDI were 94 mmHg for BDP (sensitivity,667%;specificity,936%),06 for DBI (sensitivity,80%; specificity,83%),65mmHg for CDP（sensitivity,533%;specificity,915%）.

Key words: hemodialysis accessinduced distal ischemia, arteriovenous fistula, photoplethysmography