Abstract
Flow-mediated dilation (FMD) is used to noninvasively assess the health of blood vessels and it has been shown to have a similar predictive ability for cardiovascular disease to traditional risk factors. Skin perfusion pressure (SPP) refers to the blood pressure required to restore capillary or microcirculatory flow after controlled occlusion and the return of flow. SPP has been shown to be an important measurement when making clinical decisions for patients with limb ischemia and to be a predictor of the likelihood of wound healing. Peripheral artery disease is common in hemodialysis (HD) patients. However, little is known about the association between FMD or SPP and peripheral artery disease. The aim of this study was to evaluate the association between FMD and SPP with brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) in HD patients in Taiwan, an area with a high rate of ESRD. This study was conducted at a regional hospital in southern Taiwan. ABI and baPWV values were measured using an ABI automated device. FMD and SPP were measured using ultrasound and a microvasculature blood flow monitor, respectively. Eighty patients were enrolled in this study. Compared to the patients with an ABI ≥ 0.95, those with an ABI < 0.95 had lower SPP of the feet (dorsal and plantar portions, both p < 0.001). After multivariable adjustments, low triglycerides (p = 0.033) and high calcium–phosphate product (p = 0.018) were significantly associated with low FMD. Further, low ABI (p = 0.001) and low baPWV (p = 0.036) were significantly associated with low SPP of dorsal portions. Old age (p = 0.005), low high-density lipoprotein cholesterol (p = 0.016), and low ABI (p = 0.002) were significantly associated with low SPP of plantar portions. This study demonstrated an association between FMD and SPP with peripheral artery disease in HD patients. Patients with low ABI and baPWV had a high risk of low SPP of the feet. However, there was no significant correlation between FMD and ABI or baPWV.
Highlights
Cardiovascular (CV) morbidity and mortality rates in hemodialysis (HD) patients are high due to endothelial dysfunction caused by uremic toxins and oxidative stress [1].Endothelial dysfunction can lead to peripheral artery disease (PAD) [2], which is a common complication in HD patients with rates ranging from 17% to 48% [3,4]
We evaluated the association between Flow-mediated dilation (FMD) and Skin perfusion pressure (SPP) with ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV)
We found that a low ABI and low baPWV were associated with low SPP of dorsal portions and that a low ABI was associated with low SPP of plantar portions
Summary
Cardiovascular (CV) morbidity and mortality rates in hemodialysis (HD) patients are high due to endothelial dysfunction caused by uremic toxins and oxidative stress [1]. Endothelial dysfunction can lead to peripheral artery disease (PAD) [2], which is a common complication in HD patients with rates ranging from 17% to 48% [3,4]. Flow-mediated dilation (FMD) is used to noninvasively assess the health of blood vessels (endothelial dysfunction) and is measured using high-resolution ultrasound [7]. It is expressed as percentage change of the arterial diameter from the baseline diameter [8]. FMD has been used in both clinical research and clinical practice [9], and it has been shown to be strongly predictive of future CV events in patients with diabetes mellitus (DM) [10]
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