Background: Diabetes is a widespread noncommunicable disease affecting an estimated 463 million adults worldwide in 2019 and will affect 700 million by 2045. Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Ankle Brachial Index (ABI) may inaccurately assess lower extremity perfusion in patients with highly calcified, no compressible tibial arteries. focused Arterial duplex ultrasound (DUS) of the distal anterior and posterior tibial arteries at the ankle can be readily learnt by novices (nurse/physician) and performed rapidly and accurately for early diagnosis and referral.

Objectives: The primary aim of this study is to determine the diagnostic accuracy of the DUS and ABI tests in detecting peripheral arterial disease (PAD) in diabetic patients on hemodialysis (HD) to improve early detection and diagnosis.

Methods: We conducted cross section study-single center experience-on 115 diabetic patients from 212 total patients on regular HD in the 2nd biggest dialysis center in Oman for six months (from 1st of February 2023 to end of July 2023) and we will use Ankle brachial index (ABI) and Arterial duplex ultrasound (DUS) in early detection and early diagnosis of diabetic foot ischemia. We collected the data in three sheets:1- Demographic data: age, gender, comorbidity, duration of DM, smoking and vascular access of hemodialysis. 2 -laboratory data: random blood sugar, HGB, PTH, phosphorus, lipid profile and serum albumin.3- physical foot examinations & image

Results: The study was investigated about 115 diabetic patients undergoing regular hemodialysis from 212 total numbers of our hemodialysis unit. Only 52 patients had weak pulse will focus in our study, two of them expired before complete examination so excluded from the study. Mean age of patients was 59.6 ± 11.9 years, extremes (35-83 y), 50% equal male to female. All the target patients in the study (50 Patients) are type 2 DM with duration >10 years.8%had foot ulcer and 16% had partial or complete foot amputation. Referral to vascular consultation (due to DUS -PSV<40) as suspected Ischemia 27/50=54% while ABI detect only 20% as suspected ischemia. Suspected cases of vascular insufficient to total diabetic patients in the unit 27/115=23.4 %.

Conclusion: physical examination and Ankle Brachial Index (ABI) are disturbed by the presence of calcified and incompressible blood vessels. Point-of-care arterial duplex ultrasound (DUS) may provide an alternative solution to diagnosis of Diabetic foot ischemia in HD patients. The results of this study will improve the diagnosis of PAD in diabetes and inform early referral pathways between HD units and vascular and intervention radiology in tertiary hospital.