Topical Oxygen Therapy Use in Patients with ESKD in Qatar: A Case Series

Background: End-stage kidney disease (ESKD) is an increasing healthcare concern. The major etiology is attributed to diabetes worldwide. Diabetic foot disease (DFD) is a serious complication as its the major cause of non-traumatic lower extremity amputations. ESKD is a known independent risk factor for foot ulcers in patients with diabetes, furthermore they are predisposed to other ulcerating conditions such as calcific uremic arteriolopathy (CUA). Topical oxygen therapy (TOT) has emerged as one of the modalities to improve wound healing in patients with DFD. It can be provided as an in-center treatment during hemodialysis (HD) thus bypassing some of the difficulties encountered with hyperbaric oxygen therapy. In this case series we aimed to evaluate the use of TOT in patients with ESKD. Methods: 6 patients receiving HD were identified, 5 patients diagnosed with DFD and 1 with CUA. All patients received standard of care which included thrice weekly wound examination, debridement as needed, dressing, wound swab and antibiotics if signs of infection were found. TOT was started thrice weekly during HD for 1.5 hours at 40–50 millibars of pressure and was continued till wound closure or for a total of 20 sessions. Wound dimensions were obtained before initiation of TOT and when an outcome is met. Results: All patients included received standard of care alone for at least 2 months prior to TOT without significant improvement. All patients had hypertension and diabetes. One patient was excluded as he travelled abroad. All patients tolerated the treatment without reported side effects. 3/5 patients improved with topical oxygen therapy on completion of 20 sessions. Patient 1 had complete wound closure. Patient 2 and 3 achieved significant improvement; their wounds dimensions has improved to 0.6x.0.4 cm from 1.1x0.8 cm and 0.7x0.5 cm from 4x2.2 cm respectively. Patient 4 and 5 did not complete treatment as they developed infections requiring hospitalization. Conclusion: Topical oxygen therapy is a well-tolerated adjuvant therapy that was associated with higher rates of wound healing amongst patients with end-stage kidney disease. it can be provided as an in-center treatment therefore improving patient’s adherence and convenience. Prospective trials are needed to further evaluate safety and efficacy of TOT in patients with end-stage kidney disease.