High prevalence of peripheral arterial disease (PAD) in incident hemodialysis patients: screening by ankle-brachial index (ABI) and skin perfusion pressure (SPP) measurement

Kunihiro Ishioka,Takayasu Ohtake,Hidekazu Moriya,Machiko Oka,Sumi Hidaka,Yasuhiro Mochida,Kyoko Maesato,Shuzo Kobayashi

doi:10.1186/s41100-018-0168-5

Kunihiro Ishioka, Takayasu Ohtake + Show 6 more

Open Access

https://doi.org/10.1186/s41100-018-0168-5

Copy DOI

Journal: Renal Replacement Therapy	Publication Date: Jul 18, 2018
Citations: 8	License type: open-access

Affiliation: Shonan Kamakura General Hospital

Abstract

BackgroundPeripheral arterial disease (PAD) has much impact on mortality in hemodialysis (HD) patients. Ankle-brachial index (ABI) and skin perfusion pressure (SPP) are useful tools to detect PAD in HD patients. However, the prevalence of PAD in incident HD patients by ABI and SPP measurement has not been fully elucidated.MethodsWe examined both ABI and SPP in 185 consecutive patients with end-stage renal failure at the initiation of HD therapy. PAD was diagnosed by previous history, clinical symptoms, histories of endovascular peripheral intervention, bypass surgery, amputation due to PAD, and values of ABI and SPP. Cut-off value of ABI and SPP for diagnosing PAD was set at < 0.9 and < 50 mmHg, respectively.ResultsThe percentage of limbs with ABI < 0.9 and SPP value < 50 mmHg among total limbs were 10.8 and 21.1%, respectively. Among 185 patients in incident HD patients, 45 patients were diagnosed as having PAD. ABI and SPP positively correlated (r = 0.311, p = 0.006). However, discrepancy between ABI and SPP values (normal or high ABI with low SPP, or low ABI with normal SPP) was also found. Among 45 incident HD patients with PAD, only 14 patients (31.1%) showed low ABI and low SPP values.ConclusionMeasurement of both ABI and SPP might be necessary to improve the diagnostic accuracy of PAD. Prevalence of PAD in incident HD patients was proved to be very high.

Highlights

Peripheral arterial disease (PAD) has much impact on mortality in hemodialysis (HD) patients
Once PAD worsens to severe disease state, critical limb ischemia (CLI) which necessitates major amputation of lower limbs, the prognosis is severely poor, i.e., 1-year survival rate 30–50% [2, 3] and 5-year survival rate 14.4% [3]
We examined Ankle-brachial pressure index (ABI) and skin perfusion pressure (SPP) in 185 consecutive incident HD patients to compare the results of two diagnostic methods, to evaluate the relationship between ABI and SPP, and to clarify the prevalence of PAD at the initiation of HD

Summary

Introduction

Peripheral arterial disease (PAD) has much impact on mortality in hemodialysis (HD) patients. Anklebrachial index (ABI) and skin perfusion pressure (SPP) are useful tools to detect PAD in HD patients. Peripheral arterial disease (PAD) in lower extremities in hemodialysis (HD) patients has much impact on prognosis. Amputation rate of lower limbs in HD patients is reported to be 4.3/100 person year in USA [1]. Once PAD worsens to severe disease state, critical limb ischemia (CLI) which necessitates major amputation of lower limbs, the prognosis is severely poor, i.e., 1-year survival rate 30–50% [2, 3] and 5-year survival rate 14.4% [3]. Early detection of PAD would be extremely important to improve the prognosis of HD patients. We have previously reported that the sensitivity of ABI < 0.9 for detecting PAD in HD patients was only 29.9% (specificity was 100%) [4]

Methods

Results

Conclusion