Beneficial Effect of Endovascular Therapy and Low‐Density Lipoprotein Apheresis Combined Treatment in Hemodialysis Patients With Critical Limb Ischemia due to Below‐Knee Arterial Lesions

Ohtake, Takayasu; Mochida, Yasuhiro; Matsumi, Junya; Tobita, Kazuki; Ishioka, Kunihiro; Oka, Machiko; Maesato, Kyoko; Moriya, Hideshige; Hidaka, Sumi; Saïto, Shigeru; Kobayashi, Shuzo

doi:10.1111/1744-9987.12450

Cited by 11 publications

(14 citation statements)

References 24 publications

(45 reference statements)

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“…Nutritional status was also shown to be related to the mortality of hemodialysis patients, with malnutrition increasing the mortality of patients. NRS2002 scale was used in this study to assess the nutritional status; other scales used in previous research have also indicated a relationship between malnutrition and mortality in hemodialysis patients (18). CRP contributed to the mortality of included patients in our study and has been identified as an important risk factor of mortality in hemodialysis patients in previous work (15,24).…”

Section: Discussionmentioning

confidence: 57%

“…Some effort has been made to further improve the effectiveness of EVT in hemodialysis patients. Ohtake et al attempted to combine EVT with low-density lipoprotein apheresis to treat critical limb ischemia (18). Their findings indicated that the cumulative rate of major adverse limb events was significantly improved in the combined group compared to the EVT group.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who had any ischemic symptoms including chills, numbness, resting pain, skin ulcer, or gangrene; who had previous diagnosis and treatment; or who had an ankle-brachial index (ABI) score of less than 0.9 or a toebrachial index (TBI) less than 0.6, were defined as having lower limb ischemia (18). Their demographic and clinical data, including patient age, sex, duration of hemodialysis, nutritional risk (based on nutrition risk screening 2002 score ≥3), smoking history, chronic comorbidities (including diabetes, hypertension, hyperlipidemia, coronary heart disease, cerebrovascular disease, and stroke), and Fontaine classification, were the collected by two independent investigators.…”

Section: Data Collectionmentioning

confidence: 99%

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Endovascular treatment of hemodialysis-induced lower limb artery ischemia: retrospective analysis from a single center

et al. 2021

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Background: Critical limb artery ischemia is one of common complications after hemodialysis, with endovascular therapy (EVT) having become its first-line treatment. There is no relevant study investigating the relationship between EVT and the prognosis of hemodialysis patients with critical lower limb ischemia, the most common site of vascular dysfunction.Methods: This was a retrospective, nonrandomized, single-center study. Hemodialysis patients with critical lower limb ischemia between May 2015 and October 2018 were included in this study. Their demographic and clinical data and the results of laboratory test were collected. The outcomes included all-cause mortality, amputation, and revascularization. Kaplan-Meier analysis and log-rank test were used to assess overall survival and amputation-free survival. Univariable and multivariable hazard Cox regression analyses were performed to determine risk factors of amputation and mortality.Results: In all, 67 hemodialysis patients were finally included in this study. The median age of included patients was 69.8±8.7 years, and the median duration of hemodialysis was 44.1±9.2 months. There was no significant difference between patients receiving and not receiving EVT in collected demographic and clinical data except for the duration of hemodialysis (46.1±9.0 vs. 41.7±9.0 months; P=0.048). The level of high-density lipoprotein cholesterol (HDL-C) in patients receiving EVT was 1.4±0.6 mmol/L, which was significantly lower than the 1.9±0.6 mmol/L in patients not receiving EVT (P<0.001). The results from the Kaplan-Meier curves indicated that the incidences of all-cause mortality and amputation were much lower in patients receiving EVT than in those not receiving EVT (P=0.038 and P=0.020). Hazard Cox regression analysis also indicated that EVT played protective role in all-cause mortality and amputation in hemodialysis patients with lower limb ischemia. Age, nutritional risk, stroke, and C-reactive protein (CRP) were also determined as independent risk factors of all-cause mortality according to multivariable analysis.Additionally, duration of hemodialysis and smoking history were identified as independent risk factors of amputation.Conclusions: EVT could be an efficient treatment for critical lower limb ischemia in hemodialysis patients to reduce all-cause mortality and the incidence of amputation. Moreover, some risk factors, such as malnutritional and stroke, should be avoided to improve the prognosis of hemodialysis patients.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

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Endovascular treatment of hemodialysis-induced lower limb artery ischemia: retrospective analysis from a single center

et al. 2021

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“…Lipoprotein apheresis has also shown promising results in treatment of nephropathy in diabetes mellitus and nephrotic syndrome of various etiologies . It has been suggested that lipoprotein apheresis can reduce the risk of in‐stent coronary restenosis in the early postimplantation period, and also have favorable effects in patients with critical limb ischemia due to below‐knee arterial lesions . In these studies, double filtration plasmapheresis, dextran sulfate plasma adsorption, and heparin‐induced, extracorporeal LDL precipitation were used as lipoprotein apheresis systems.…”

Section: Introductionmentioning

confidence: 99%

Comparison of cytokine changes in three different lipoprotein apheresis systems in an ex vivo whole blood model

Hardersen

Enebakk

Christiansen

et al. 2019

J of Clinical Apheresis

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Introduction: Even if proprotein convertase subtilisin/kexin type 9 inhibitors have replaced lipoprotein apheresis in many patients, lipoprotein apheresis still is an important option in homozygous familial hypercholesterolemia, progressive atherosclerosis or when removal of lipoprotein(a) is indicated. Additional possible favorable effects beyond lipid lowering could include changes in the concentration of cytokines and improvement of hemorheology. Methods: We evaluated how whole blood adsorption, dextran sulfate plasma adsorption, and double filtration plasmapheresis lipoprotein apheresis systems affected cytokine concentrations, using a human whole blood ex vivo model differentiating the effect of the lipoprotein apheresis and plasma separation columns and describing temporal changes.

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“…7,8 For these patients, additional conservative therapies, such as low-density lipoprotein apheresis, hyperbaric oxygen therapy, and spinal cord stimulation were administered. 9-14 However, they were not effective in several cases. In contrast, some reports indicated that nitrate patch is useful therapy for patients with PAD.…”

mentioning

confidence: 99%

The Efficacy of the Transdermal Isosorbide Dinitrate Patch in Patients With Chronic Limb-Threatening Ischemia

Matsui

Murakami

Hata

et al. 2020

The International Journal of Lower Extremity Wounds

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Recently, the number of patients with peripheral artery disease (PAD), including those with chronic limb-threatening ischemia (CLTI), has increased because of the increasing number of diabetic or dialysis patients worldwide. Revascularization is an important therapy for patients with CLTI. However, we sometimes experience refractory cases with insufficient peripheral circulation or microcirculation after revascularization. In this situation, additional therapy can be administered, such as low-density lipoprotein apheresis, high-pressure oxygen therapy, and spinal cord stimulation. However, they are not effective in some cases. Some reports have also indicated that transdermal isosorbide dinitrate patch (ISDN-P) is a useful therapy for PAD. As the efficacy of ISDN-P for patients with CLTI is not well-known, we examined it in this study. We assessed the skin perfusion pressure (SPP) after affixing an ISDN-P on the foot, because SPP measurement has proved useful in the assessment of PAD and is a good indicator of wound healing potential. The SPP (dorsal and plantar aspects) after ISDN-P application on the foot of healthy volunteers increased (n = 8; mean ± SD, 12.6 ± 7.9 [ P = .12], and 21.2 ± 7.7 mm Hg [ P < .05], respectively), as did SPP of patients with CLTI (n = 10; mean ± SD, 19.8 ± 2.5 [ P < .01], and 14.1 ± 5.9 mm Hg [ P < .05], respectively). All the patients who received an ISDN-P on the foot had no major complication, and no significant change in blood pressure. In conclusion, the ISDN-P is one of the effective and safe therapies for patients with CLTI.

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Beneficial Effect of Endovascular Therapy and Low‐Density Lipoprotein Apheresis Combined Treatment in Hemodialysis Patients With Critical Limb Ischemia due to Below‐Knee Arterial Lesions

Cited by 11 publications

References 24 publications

Endovascular treatment of hemodialysis-induced lower limb artery ischemia: retrospective analysis from a single center

Endovascular treatment of hemodialysis-induced lower limb artery ischemia: retrospective analysis from a single center

Comparison of cytokine changes in three different lipoprotein apheresis systems in an ex vivo whole blood model

The Efficacy of the Transdermal Isosorbide Dinitrate Patch in Patients With Chronic Limb-Threatening Ischemia

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