Peripheral Arterial Disease In Hemodialysis Patients Research Articles

Clinical Outcomes of Drug-Coated Balloon Angioplasty in Peripheral Artery Disease Patients With End-Stage Renal Disease.

The objective was to determine the effectiveness and safety of paclitaxel-coated balloon angioplasty in hemodialysis patients with diabetic nephropathy (DN). The outcomes of end-stage renal disease (ESRD) patients with peripheral artery disease (PAD) and treated with drug-coated balloon (DCB) angioplasty were retrospectively evaluated. The effectiveness outcomes were clinical improvement of the Rutherford classification and target lesion revascularization (TLR). Safety outcomes were all-cause mortality and amputation. Ninety-seven patients were treated with DCB angioplasty between December 2018 and December 2020. 87 (63.8±10.1 years) achieved technical success. Most patients had a Rutherford classification of at least grade 4. The mean lesion length was 169.8±73.8 mm, almost all had arterial calcification, and 31.0% had annular calcification. Wounds were present in 73.6% of the target limbs. The mean follow-up in this cohort was 13.4±7.4 months. The wound healing rate was 61.5% at the 12-month follow-up. All-cause mortality during 12 months of follow-up was 35.6%, amputation-free survival was 58.6%, and TLR was observed in 13 (15.3%) patients. At 3 and 12 months of follow-up, the Rutherford grade significantly improved (p<0.001). The Cox proportional hazards model revealed that wounds (hazard ratio [HR]=1.404, p=0.023) and annular calcification (HR=2.076, p=0.031) were independent predictors of amputation-free survival. Drug-coated balloon angioplasty in ESRD patients was effective and safe over the medium term. Wounds and annular calcification were independent predictors of amputation-free survival. The effectiveness of DCB angioplasty in ESRD patients and the factors affecting major outcome prognosis in this population remain limited. This study contributes valuable insights into the effectiveness and safety of paclitaxel-coated balloon angioplasty for PAD in hemodialysis patients. Medical professionals can now regard DCB angioplasty as a viable treatment. Identifying wound presence and annular calcification as predictors of amputation-free survival equips medical practitioners with a more tailored approach to patient management, potentially resulting in enhanced outcomes and more precise treatment strategies.

Association of diabetic retinopathy with risk of developing cardiovascular diseases in patients undergoing hemodialysis: A population-based cohort study

Background and aimsWhile patients undergoing dialysis have substantially increased cardiovascular event rates compared with the general population, predicting individual risk remains difficult. Whether diabetic retinopathy (DR) is associated with cardiovascular diseases in this population is unclear. Methods and resultsWe conducted a nationwide cohort study of 27,686 incident hemodialysis patients with type 2 diabetes who were enrolled in Taiwan's National Health Insurance Research Database between January 1, 2010, and December 31, 2014, and had follow-up data until December 31, 2015. The primary outcome was a composite of macrovascular events, including acute coronary syndrome (ACS), acute ischemic stroke, and peripheral artery disease (PAD). A total of 10,537 (38.1%) patients had DR at baseline. We matched 9164 patients without DR (mean age, 63.7 years; 44.0% women) to 9164 patients with DR (mean age, 63.5 years; 43.8% women) by propensity score. During a median follow-up of 2.4 years, 5204 patients in the matched cohort experienced a primary outcome. The presence of DR was associated with a higher risk of a primary outcome (subdistribution hazard ratio [sHR] 1.07; 95% CI, 1.01–1.13), which reflected a higher risk of acute ischemic stroke (sHR 1.26; 95% CI, 1.14–1.39) and PAD (sHR 1.14; 95% CI, 1.05–1.25) but not ACS (sHR 0.99; 95% CI, 0.92–1.06). ConclusionsThe presence of DR signifies an increased risk of acute ischemic stroke and PAD in hemodialysis patients with type 2 diabetes, independent of the known risk factors. These results highlight the need for more comprehensive cardiovascular assessment and management in hemodialysis patients with DR.

The fluctuation of skin perfusion pressure in hemodialysis patients treated with LDL apheresis therapy: A comparison of LDL adsorption and double filtration plasmapheresis.

There have been a number of reports suggesting that LDL apheresis, including LDL adsorption and double filtration plasmapheresis (DFPP), can be applied for the treatment of lower extremity peripheral arterial disease (PAD) in hemodialysis patients, whereas there is no definitive recommendation for the use of LDL apheresis. The change of skin perfusion pressure (SPP) during LDL apheresis was measured in every single treatment to determine the effect of LDL adsorption and DFPP on improving blood flow in lower extremity PAD hemodialysis patients. Eleven hemodialysis patients treated with more than two series of LDL apheresis were involved in the study. "One series" included 10 treatments of LDL apheresis according to the Japanese health care insurance system. In total, 320 treatments (32 series) of LDL apheresis were performed utilizing either LDL adsorption or DFPP treatment in 11 patients. The SPP values pre- and post-apheresis were recorded in 315 treatments (228 LDL adsorption and 87 DFPP). The SPP was significantly improved after both LDL adsorption (P < .001) and DFPP (P=.002) treatment. The median change of SPP was significantly larger in the LDL adsorption group (12.6 mm Hg, range: -48.5, 77.0 mm Hg) than in the DFPP group (6.7 mm Hg, range: -42.0, 72.5 mm Hg) (P=.003). The LDL adsorption consistently offered a significant increase in the SPP, whereas DFPP treatment seemed to have modest effects on the improvement of SPP compared to the LDL adsorption. These data indicate that LDL adsorption should be considered the primary LDL apheresis therapy for lower extremity PAD in hemodialysis patients to achieve improvement of blood flow.

Peripheral Arterial Disease among Patient Undergoing Maintenance Hemodialysis in Dakar (Senegal)

Background: Peripheral arterial disease (PAD) is common in patients with chronic kidney disease (CKD). It is a surrogate marker of generalized atherosclerosis. In sub-Saharan Africa, PAD remains understudied in CKD. Ankle-brachial index (ABI) is a non-invasive and cost-effective tool to diagnose PAD. Objectives: Our aim was to determine the prevalence and associated risk factors for PAD in hemodialysis patients. Patients and Methods: We conducted a cross-sectional study from July 1 to December 31, 2012 in the department of Nephrology of the University Hospital Aristide le Dantec of Dakar. All consenting patients, aged above 18 years, on hemodialysis for at least 6 months were included. ABI measurements were performed using a handled pulse doppler. PAD was defined as an ABI of <0.9 or the history of surgical revascularization and/or amputation due to vascular disease. The patients were divided into two groups according to the presence or not of PAD. Standard blood tests and anthropometrical parameters were recorded. Results: A total of 53 patients with a mean age of 49.15 ± 15.18 were included. The sex ratio was 0.70. Hypertension (83.01%), low HDL-cholesterol (26.41%) and cigarette smoking (20.75%) were the main cardiovascular risk factors. Prevalence of PAD was 47.16%. Among patients with PAD, 52% had no suggestive symptoms. Lower pre-dialysis (p = 0.0384) and post-dialysis (p = 0.0447) diastolic blood pressure (BP) were significantly associated with PAD. The conventional risk factors (tobacco consumption, diabetes, alcohol consumption, dyslipidemia, hypertension, age), iPTH and CRP levels were not correlated with PAD. Conclusion: PAD is common among patients undergoing maintenance hemodialysis in Senegal. Early diagnosis and management of PAD should be routinely performed in CKD patients.

P1593THE ASSOCIATION BETWEEN THE ANCLE-BRACHIAL INDEX AND MARKERS OF INFLAMATION IN CHRONIC HEMODIALYSIS PATIENTS

Abstract Background and Aims Among hemodialysis patients, peripheral arterial disease (PAD) represents an important health care burden and has been associated with high mortality. The ancle-brachial index (ABI), is a reliable and noninvasive method used to asses PAD. The aim of this study was to evaluate the prevalence of PAD in patients undergoing chronic hemodialysis and the association with inflammation and malnutrition using serum C-reactive protein (CRP) and serum albumin as biomarkers. Method The study was conducted at different hemodialysis centers in patients receiving hemodialysis three times a week. We excluded patients with atrial fibrillation or who had been recently hospitalized. The ABI has been used as a diagnostic tool for PAD and measured before a hemodialysis session. A value of ABI less than 0.9 was considered abnormal. To better estimate the impact of malnutrition and inflammation we used the serum albumin, blood lipids values and serum C-reactive protein values defined by calculating the mean of the last three measurements. Results A total of 261 ESRD patients on maintenance hemodialysis were enrolled in the study. Mean age was 56.0 (±12) years, 58% were males, and 17.6% were diabetics. Mean time on hemodialysis was 5.9 (±6.7) years, with 24% of patients on dialysis for less than 3 years. Among our patients we found that the prevalence of PAD was 23.4%, of whom 58.1% were men. We found that age, diabetes, duration of hemodialysis, low serum albumin levels and high serum triglyceride levels were risk factors for PAD in hemodialysis patients. The multivariate analysis of our study has shown that a lower level of albumin and higher level of CRP were significantly associated with an ABI less than 0.9 (odds ratio, 4.54; 95% confidence interval, P = 0.017) after adjusting for demographic, clinical, biochemical and medication data. We did not find significant differences in serum calcium, phosphate or PTH levels between patients with PAD and those without it. Conclusion In conclusion, the present study showed high prevalence of PAD in patients on hemodialysis. The prevalence was higher in diabetics. Low albumin levels and C-reactive levels were independent risk factors of PAD. We found that early diagnosis and treatment of PAD could help to improve the quality of life of hemodialysed patients and postpone arterial complications in this group of patients.

A4142 Omega-3 fatty acid has effect on improvement of peripheral artery disease in correlation with degree of lowering remnant-like lipoprotein cholesterol in hemodialysis patients with dyslipidemia

Objectives: Recently, we showed the therapeutic effect of high dose omega-3 fatty acid (EPA/DHA) on peripheral artery disease (PAD) by lowering remnant-like lipoprotein cholesterol (RLP-C) in hemodialysis patients with dyslipidemia. In the present study, we aimed to investigate whether improving effect on PAD by lowering RLP-C can be observed even in low dose of EPA/DHA. Methods: We randomly assigned 38 hemodialysis patients with dyslipidemia to receive either add-on of high dose EPA/DHA (1860 mg of EPA and 1500 mg of DHA) with conventional therapy (H group: n = 19) or conventional therapy alone (C group) for 3 months. Sixteen out of 19 patients enrolled in the C group continued the study for another 3 months add-on of low dose EPA/DHA (930 mg of EPA and 750 mg of DHA: L group). RLP-C as an atherogenic lipid parameter, and ankle-brachial index (ABI) as an index of PAD were measured before and after the intervention. Results: After 3 months intervention of EPA/DHA, RLP-C and ABI changed by − 3.25 ± 3.15 mg/dL and 0.07 ± 0.11 in H group, by − 0.37 ± 3.50 mg/dL and − 0.01 ± 0.14 in L group (between group difference, p = 0.015 and p = 0.049, respectively). There was a significant negative correlation between the change in RLP-C and the change in ABI in H group (r = − 0.475, p = 0.040) and it was also significant when L group was analysed together (r = −0.546, p = 0.001). The change in RLP-C was an independent determinant of the change in ABI after adjustment for confounding factors in H and L group analyzed together (p < 0.001). Conclusion: Low dose EPA/DHA did not show decrease in RLP-C or improvement of PAD, supporting the fact that the degree of lowering RLP-C is a key factor for improving effect of PAD in hemodialysis patients with dyslipidemia undergoing conventional therapy such as use of statin.

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

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.

A reconciling criterion for early detection of asymptomatic PAD in HD patients

Peripheral arterial disease (PAD), an important manifestation of systematic atherosclerosis, is common in hemodialysis (HD) patients, while usually underdiagnosed because most patients were asympto...

Nationwide Trends in Hospital Outcomes and Utilization After Lower Limb Revascularization in Patients on Hemodialysis

ObjectivesThis study aimed to describe the temporal trends and outcomes of endovascular and surgical revascularization in a large, nationally representative sample of patients with end-stage renal disease on hemodialysis hospitalized for peripheral artery disease (PAD). BackgroundPAD is prevalent among patients with end-stage renal disease on hemodialysis and is associated with significant morbidity and mortality. There is a paucity of information on trends in endovascular and surgical revascularization and post-procedure outcomes in this population. MethodsWe used the Nationwide Inpatient Sample (2002 to 2012) to identify hemodialysis patients undergoing endovascular or surgical procedures for PAD using diagnostic and procedural codes. We compared trends in amputation, post-procedure complications, mortality, length of stay, and costs between the 2 groups using trend tests and logistic regression. ResultsThere were 77,049 endovascular and 29,556 surgical procedures for PAD in hemodialysis patients. Trend analysis showed that endovascular procedures increased by nearly 3-fold, whereas there was a reciprocal decrease in surgical revascularization. Post-procedure complication rates were relatively stable in persons undergoing endovascular procedures but nearly doubled in those undergoing surgery. Surgery was associated with 1.8 times adjusted odds (95% confidence interval: 1.60 to 2.02) for complications and 1.6 times the adjusted odds for amputations (95% confidence interval: 1.40 to 1.75) but had similar mortality (adjusted odds ratio: 1.05; 95% confidence interval: 0.85 to 1.29) compared with endovascular procedures. Length of stay for endovascular procedures remained stable, whereas a decrease was seen for surgical procedures. Overall costs increased marginally for both procedures. ConclusionsRates of endovascular procedures have increased, whereas those of surgeries have decreased. Surgical revascularization is associated with higher odds of overall complications. Further prospective studies and clinical trials are required to analyze the relationship between the severity of PAD and the revascularization strategy chosen.

Electronegative low-density lipoprotein increases the risk of ischemic lower-extremity peripheral artery disease in uremia patients on maintenance hemodialysis

Electronegative low-density lipoprotein (LDL) has been shown to increase coronary artery disease risk in hemodialysis patients, but its effect on the risk of peripheral artery disease (PAD) remains unclear. We separated plasma LDL from 90 uremia patients undergoing hemodialysis into 5 subfractions (L1–L5) according to charge by using fast-protein liquid chromatography with an anion-exchange column and examined the distribution of L5—the most electronegative LDL subfraction—in total LDL (i.e. L5%). During a 5-year period, we followed up with these patients until the occurrence of ischemic lower-extremity PAD. During the follow-up period, ischemic lower-extremity PAD developed in 24.4% of hemodialysis patients. L5% was higher in hemodialysis patients in whom ischemic lower-extremity PAD occurred (3.03% [IQR, 2.36–4.54], n = 22) than in hemodialysis patients in whom PAD did not occur (1.13% [IQR, 0.90–1.83], n = 68) (p < 0.001). Furthermore, L5% significantly increased the adjusted hazard ratio of ischemic lower-extremity PAD (1.54 [95% CI, 1.14–2.10]) (p = 0.005). Flow-mediated dilation was negatively associated with L5% (p < 0.001). Additionally, in vivo experiments from mice showed that L5 compromised endothelium-dependent vascular relaxation through a nitric oxide–related mechanism. Our findings indicate that increased L5% may be associated with the occurrence of ischemic lower-extremity PAD in hemodialysis patients.

Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis.

BackgroundRecent studies have shown an association between peripheral arterial disease (PAD) and increased risk of mortality in hemodialysis (HD) patients; however, the estimates vary widely and are inconsistent. It is necessary to elucidate the degree of mortality risk for PAD patients in HD population.MethodsPubMed, EMBASE, Web of Science and Cochrane Library (from inception to September 4th, 2016) were systematically searched for cohort studies assessing the association between PAD and mortality in HD patients. We calculated the pooled risk ratios (RRs) with 95% confidence intervals (CI) of all-cause and cardiovascular (CV) mortality using random effects models. Subgroup analyses were conducted to explore the source of heterogeneity.ResultsThe search identified 2,973 potentially eligible records and 10 studies (n = 32,864) were included. Our meta-analysis revealed that PAD significantly increased the risk of all-cause mortality (RR 2.15, 95 % CI 1.67–2.77, n = 32,864) and CV mortality (RR 2.99, 95 % CI 1.66-5.38, n = 31,794) in HD patients after multivariate adjustment. Subgroup analyses showed the study design and follow-up time might be two sources of heterogeneity.ConclusionPAD may be a prognostic marker of all-cause and CV mortality in HD patients. More attention should be paid to diagnosis and management of PAD in HD patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0397-1) contains supplementary material, which is available to authorized users.

Association of adiponectin with peripheral arterial disease and mortality in nondiabetic hemodialysis patients: Long-term follow-up data of 7 years.

Background:The relationships between adiponectin and clinical outcomes in hemodialysis (HD) patients remain highly controversial. Meanwhile, the association between adiponectin and the peripheral artery disease (PAD) has not been well studied in HD patients without diabetic mellitus.Materials and Methods:The ankle-brachial index was measured in HD patients. Adiponectin levels in 105 HD patients were measured by Enzyme-Linked Immunosorbant Assay.Results:105 HD patients were enrolled; 14 (13%) patients had PAD. Using receiver-operating-characteristic (ROC) curve analysis for PAD, adiponectin (area under the curve [AUC] 0.935, 95% confidence interval [CI]: 0.848–0.981, P < 0.001) showed significantly positive predictive value. During follow-up (mean 63 ± 30 months), 34 deaths (32%) occurred. Kaplan–Meier analysis found those patients lower median adiponectin had a significantly poor outcome (P < 0.05), and Cox analysis further confirmed that adiponectin was an independent predictor of overall mortality (hazard ratio [HR], 0.832, 95% CI: 0.696–0.995, P < 0.05). The ROC curve of overall mortality showed that the AUC of adiponectin was 0.719 (95% CI: 0.586–0.813, P < 0.05). In HD patients with PAD, the univariate analysis showed that adiponectin (HR, 0.649, 95% CI: 0.527–0.800, P < 0.001) was also associated with overall mortality.Conclusion:Decreasing levels of adiponectin were associated with a significant increase in the risk of PAD in HD patients without diabetic mellitus. Furthermore, as the results of our observation period (maximum of 7 years) showed, adiponectin was a predictor of all-cause mortality in HD patients.

Decreased physical activity is associated with an increased incidence or progression of peripheral artery disease in hemodialysis patients

Background:Hemodialysis patients are at a higher risk of developing peripheral artery disease (PAD) than the general population. However, factors associatedwith the incidence or progression of PAD in hemodialysis patients have not been fully elucidated. Furthermore, very few studies have assessed the associationbetween the development of PADandphysical activity levels, although most of hemodialysis patients have low levels of daily physical activity and are thus prone to arteriosclerosis. Purpose: The purpose of this study was to examine whether physical activity levels contribute to the development of PAD in hemodialysis patients using multivariate analyses adjusted for clinical variables. Methods: This prospective study followed Japanese outpatients undergoing maintenance hemodialysis three times a week at the Hemodialysis Center from July 2012 to January 2013 for one year. Patients who had been treated with percutaneous transluminal angioplasty and/or stenting, had an ankle-brachial index (ABI) ≥1.40 at baseline, had noncompliance with prescribed medications (antiplatelet and statin drugs), and showed changes in physical activity levels during the observation period due to adverse clinical events were excluded. Age, sex, body mass index, dialysis vintage, history of smoking, comorbid conditions, blood biochemical data (creatinine, calcium-phosphate products, low and high-density lipoprotein cholesterol, triglyceride, and intact parathyroid hormone), levels (high or low) of physical activity, and ABI were obtained from clinical records at baseline. Patients were classified as having a low physical activity level if they used wheelchair at home/hospital, required walking assistance, or had limited ambulation at/around home. For analysis, patients were divided into groups with or without newly diagnosed PAD (ABI ≥1.00 at baseline and ABI ≤0.99 at the endpoint), and with or without progressive PAD (ABI ≤0.99 at baseline and subsequent decrease in ABI to ≥0.10) according to changes in ABI during the study period. Multivariate logistic regression analyses adjusted for baseline clinical variables were performed to identify the prognostic effect of physical activity levels on PAD incidence or progression after one year. Analysis was performed using the Statistical Package for Social Sciences (SPSS version 21, USA). Results: A total of 124 eligible Japanese outpatients (mean age, 65.7± 10.7; male, 52.4%; mean hemodialysis vintage, 9.9± 8.6 years) were included in the study. During the follow-up period, 13 hemodialysis patients (10.5%) were newly diagnosed or had progressive PAD. Adjusted multivariate logistic regression analyses revealed a significant association between PAD incidence or progression and physical activity levels (odds ratio, 5.504; 95% confidence interval, 1.653–18.326; P= 0.005). Conclusion(s):Decreased physical activity is closely and independently associated with an increased incidence or progression of PAD in hemodialysis patients. Implications: Hemodialysis patients reportedly have significantly lower physical activity levels compared to age-matched community-dwelling people. Regular physical therapy to increase habitual physical activity should be considered as an effective approach to prevent the development of PAD in clinically stable hemodialysis patients.

Plasma Pentraxin 3 Is Closely Associated with Peripheral Arterial Disease in Hemodialysis Patients and Predicts Clinical Outcome: A 6-Year Follow-Up

Background: The aim of this study is to investigate the value of plasma PTX3 level for assessing peripheral artery disease (PAD) and clinical outcome in hemodialysis (HD) patients. Methods: The ankle-brachial index (ABI) was measured in HD patients. PTX3 levels in 116 HD patients were measured by ELISA. Results: Overall, 116 HD patients were enrolled; 21 (18%) patients had PAD. Using the ROC curve analysis for PAD, PTX3 (cut-off value 4.06 ng/ml, AUC 0.901, p < 0.0001) showed a significantly better positive predictive value than hsCRP (cut-off value 3.33 ng/ml, AUC 0.640, p < 0.05). During follow-up (mean 57 ± 26 months), 40 deaths (34%) occurred. Kaplan-Meier analysis found that those patients with elevated PTX3 had a significantly poor outcome (p < 0.0001), and Cox analysis further confirmed that PTX3 was an independent predictor of overall mortality (HR, 1.105, p = 0.03). For prediction of overall mortality, the AUC for PTX3 (cut-off value 3.22 ng/ml, AUC 0.690, p < 0.0001) was close to hsCRP (cut-off value 5.84 ng/ml, AUC 0.620, p < 0.001). Conclusions: For the prediction of PAD in HD patients, the diagnostic sensitivity and specificity of PTX3 were higher than those of hsCRP. Furthermore, PTX3 was also a predictor of all-cause mortality in HD patients. PTX3 may be considered a novel biomarker of inflammation in HD patients.

Plasma pentraxin 3 may be a better marker of peripheral artery disease in hemodialysis patients than C-reactive protein

Pentraxin 3 (PTX3) is a novel inflammatory cytokine produced in atherosclerotic plaque. We hypothesized that this marker may be a better predictor of peripheral artery disease (PAD) than C-reactive protein (CRP) in hemodialysis (HD) patients. The ankle-brachial index (ABI) was measured in HD patients. PTX3 levels in 116 HD patients and 30 healthy blood donors were measured by ELISA. A total of 116 HD patients (age: 56.44 ± 14.08 years) were enrolled; 21 (18%) patients had PAD. PTX3 was significantly higher in PAD versus non-PAD patients (5.55 ± 2.63 vs 2.32 ± 1.29 ng/mL; p < 0.001). In a univariate analysis, ABI correlated significantly with age, blood glucose and triglycerides, and plasma PTX3 (r = -0.548, p < 0.001) and high-sensitivity (hs)CRP (r = -0.495, p < 0.001). Using ROC curve analysis for PAD, PTX3 (cut-off value 4.06 ng/mL, AUC 0.901, p < 0.0001) showed a significantly better positive predictive value than hsCRP (cut-off value 3.33 mg/L, AUC 0.640, p < 0.05). Logistic regression analysis further confirmed that PTX3 (OR = 9.755, p = 0.001) was an independent predictor of PAD. In conclusion, we demonstrated that PTX3 may be a better marker of PAD than hsCRP, and independently correlated with PAD in HD patients.

Combination treatment using percutaneous transluminal angioplasty and low‐density lipoprotein apheresis in a patient with peripheral arterial disease and a history of chronic hemodialysis

Peripheral arterial disease (PAD) is very common in dialysis patients, who tend to have diffuse calcification and severe peripheral arterial stenosis that make it difficult to treat limbs using only surgical or endovascular interventions. Better ways to treat this condition are therefore required and also follow-up studies to evaluate the effects of these treatments on the microcirculation. A 59-year-old man who had a cadaveric kidney transplant five years previously after 25 years of regular hemodialysis complained of pain at rest in his right lower limb and subsequently developed an intractable decubitus ulcer on his right fifth toe (Fontaine IV). Digital subtraction angiography revealed a severe obstruction of the right femoral artery and diffuse stenosis of the right superficial femoral artery. The patient underwent percutaneous transluminal angioplasty (PTA) and six sessions of low-density lipoprotein apheresis (LDL apheresis). At the end of these sessions his complaints were almost completely alleviated. The mean elevation in skin temperature after each session was (1.58 ± 0.99)°C [mean ± SD] over the right dorsalis pedis artery and (1.52 ± 0.88)°C at the tip of the right fifth toe. Ultrasound-measured blood flow rates in the right dorsalis pedis artery were 9.2 cm/s before PTA and 20.2 cm/s one month after PTA. Hemodialysis was resumed 3 days after the PTA due to contrast-induced nephropathy. The combination of PTA and LDL apheresis is useful for treating PAD in hemodialysis patients, with the changes in peripheral artery patency are able to be evaluated effectively by measuring skin temperature.

Plasma S100A12 Levels and Peripheral Arterial Disease in End-Stage Renal Disease

Background: S100A12 is an endogenous ligand of the receptor for advanced glycation end products (RAGE). Plasma S100A12 levels are high in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (HD). Peripheral arterial disease (PAD) is common in HD patients and is associated with increased cardiovascular morbidity and mortality rates in this population. To date, however, no study has specifically assessed the relationship between plasma S100A12 and PAD in HD patients. Methods: We conducted a cross-sectional study of 152 HD patients in our affiliated hospital. We investigated PAD history and patient characteristics and quantified plasma S100A12 levels in all participants. Results: HD patients with PAD (n = 26; 21.9 [13.6–33.4] ng/ml) showed significantly higher plasma S100A12 levels than HD patients without PAD (n = 126; 11.8 [7.5–17.6]ng/ml; p < 0.001). In multivariate logistic regression analysis, the plasma S100A12 level (odds ratio [OR] 5.71; 95% confidence interval [CI] 1.29–25.3; p = 0.022) was identified as an independent factor associated with PAD prevalence. Another factor associated with PAD prevalence was the ankle-brachial index (OR 0.54; 95% CI 0.40–0.74; p < 0.001). Conclusion: These results suggest that plasma S100A12 levels are strongly associated with PAD prevalence in ESRD patients undergoing HD.

Impact of lower limbs' arterial calcification on the prevalence and severity of PAD in patients on hemodialysis

Peripheral arterial disease (PAD) is one of the serious complications in patients on hemodialysis (HD) therapy. However, arterial calcification of lower limbs' arteries and its impact on the prevalence and severity of PAD has never been quantitatively evaluated in HD patients with PAD. Ninety-seven HD patients were enrolled to evaluate calcification score in superficial femoral artery (SFACS) and below-knee arteries (BKACS) quantitatively by 64-row multidetector computed tomography as well as ankle-brachial pressure index (ABI), toe-brachial pressure index (TBI), and clinical and laboratory parameters. Forty-six patients (47.2%) had PAD, and 11 patients had critical limb ischemia (CLI). SFACS and BKACS were significantly associated with the prevalence and severity of PAD, and receiver-operating characteristic analysis showed that SFACS and BKACS well predicted the prevalence of PAD and CLI in HD patients. The independent associating factors for PAD were BKACS and low TBI (r(2) = 0.534; P < .0001). Low TBI was also an independent associating factor for CLI (r(2) = 0.245; P < .0001). Multivariate analysis indicated that the independent associating factors for TBI in HD patients were BKACS and C-reactive protein (CRP; r(2) = 0.358; P = .006). Present quantitative analysis clearly provided the first evidence that arterial calcification of lower limbs' arteries was closely associated with the prevalence and severity of PAD in HD patients. Furthermore, arterial calcification of below-knee arteries and micro-inflammation represented as CRP were the independent associating factors for low TBI, which was the independent associating factor for PAD and CLI in HD patients.