Peripheral Arterial Disease

DeLoach, Stephanie; Mohler, Emile R.

doi:10.2215/cjn.04101206

Cited by 58 publications

(58 citation statements)

References 74 publications

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“…In this study, PAD assessed on duplex US was significantly associated with older age, diabetes, smoking, decrease in Kt/V, increase in serum total cholesterol levels, and other atherosclerotic comorbidities. These associations are consistent with previous reports among hemodialysis patients (12,20,26,28). This study showed that asymptomatic PAD was 23.8% in hemodialysis patients recruited from an outpatient dialysis unit.…”

Section: Discussionsupporting

confidence: 93%

“…However, duplex US is safe, inexpensive, and accurate enough to assess PAD in clinical settings (25,26). Patients with impaired kidney function are at increased risk for gadolinium-associated nephrogenic systemic fibrosis (26,27). In this study, PAD assessed on duplex US was significantly associated with older age, diabetes, smoking, decrease in Kt/V, increase in serum total cholesterol levels, and other atherosclerotic comorbidities.…”

Section: Discussionmentioning

confidence: 67%

“…Duplex US has been reported to be less sensitive than contrast-enhanced magnetic resonance angiography in detecting stenosis in Ն50% in the lower extremity artery (24). However, duplex US is safe, inexpensive, and accurate enough to assess PAD in clinical settings (25,26). Patients with impaired kidney function are at increased risk for gadolinium-associated nephrogenic systemic fibrosis (26,27).…”

Section: Discussionmentioning

confidence: 99%

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Detection of Peripheral Artery Disease by Duplex Ultrasonography among Hemodialysis Patients

Ogata

Kumata-Maeta

Shishido

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Peripheral arterial disease (PAD) is a known predictor of cardiovascular morbidity and mortality among hemodialysis patients. Although ankle-brachial BP index (ABI) is a simple and reliable test for PAD screening, its sensitivity has been suggested to decrease among dialysis patients.Design, setting, participants, & measurements: We performed a cross-sectional outpatient cohort study to examine prevalence of PAD among hemodialysis patients using duplex ultrasonography of the lower extremity artery. We also evaluate the influence of increased arterial stiffness on impaired accuracy of ABI for PAD screening.Results: Of 315 total patients, 23.8% had PAD. PAD was associated with younger age, diabetes, current smoking, atherosclerotic comorbidities, increased total cholesterol levels, increased triglyceride levels, and lower Kt/V. The receiver operating characteristic analysis (area under the receiver operating characteristic curve ‫؍‬ 0.846) showed that sensitivity and specificity of ABI values for PAD were 49.0 and 94.8%, respectively. An ABI cut-off value of 1.05 resulted in the best sensitivity (74.5%) and specificity (84.4%). There was a significant difference in sensitivity of ABI levels <0.9 for detecting PAD among patients in different brachial-ankle pulse wave velocity quartiles. In patients with the highest brachial-ankle pulse wave velocity quartile, PAD was most prevalent (46.5%), and ABI had the highest accuracy in detecting PAD (area under the curve, 0.933).Conclusions: These results suggest that duplex ultrasonography was a useful tool for screening asymptomatic PAD among hemodialysis patients and that the diagnostic value of ABI for PAD was affected by various factors.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Detection of Peripheral Artery Disease by Duplex Ultrasonography among Hemodialysis Patients

Ogata

Kumata-Maeta

Shishido

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…As described elsewhere, [2,18] hemodialysis patients are known to have general atherosclerotic disease with high prevalence of peripheral arterial occlusive disease (PAOD) and amputations. According to our data, the hemodialysis procedure can contribute to the impairment of peripheral microcirculation and peripheral ischemia together with PAOD.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Skin Microcirculation during Hemodialysis

et al. 2010

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Background. Cardiovascular mortality in hemodialysis (HD) patients remains high despite improvements in HD technique such as dialysis adequacy, dialysis fluid purity, and membrane biocompatibility. Optimal fluid balance to maintain optimal hemodynamic stability during hemodialysis (HD) procedure is essential. At the present time, hemodynamic stability is conventionally assessed as stability of macrocirculation, especially as maintenance of systemic blood pressure with no attention paid to peripheral perfusion. Peripheral ischemic vascular disease represents a serious problem with high mortality and morbidity. We estimated skin microcirculation changes during HD using new device, Laser Doppler Line Scanner (Moor Instruments, Devon, UK). Aims. The aims were to introduce the novel method of detection of skin perfusion changes during hemodialysis and to evaluate possible relationship of these to ultrafiltration as well as to selected biochemical characteristics. Methods. In 36 hemodynamically stable patients, we performed paired measurements of skin blood flow in both hands before and during HD with registering the time of dialysis and the total ultrafiltration achieved. Results. We found a significant decrease in a majority of the evaluated areas. However, the skin blood flow change was not homogenous as it decreased more on the fingers. Conclusion.To our knowledge, this is the first study when the microcirculatory changes during hemodialysis are demonstrated and evaluated in large skin surface area, and showing not only a decrease in a majority of areas but also the heterogeneity of the changes.

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“…1,2 Vascular repair mechanisms in patients with CKD are poorly understood. Bone marrowderived endothelial progenitor cells (EPCs) are involved in the reparative processes of the cardiovascular system.…”

Section: Introductionmentioning

confidence: 99%

Effect of darbepoetin alfa on endothelial progenitor cells and vascular reactivity in chronic kidney disease

et al. 2011

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Endothelial progenitor cells (EPCs) are thought to be important for maintaining normal vascular function. We conducted a prospective study evaluating the effect of the erythropoiesis-stimulating agent darbepoetin alfa on EPCs and vascular function in patients with chronic kidney disease (CKD), with or without diabetes. Thirty subjects with CKD (20 subjects with type II diabetes mellitus and 10 without diabetes mellitus) received weekly subcutaneous administration of darbepoetin alfa for 4 weeks. EPCs were measured at baseline and 2 and 4 weeks after drug administration. Vascular function was measured with brachial ultrasound and cell activity was measured with a cell proliferation assay. Cells expressing CD133, CD34, CD146 and CD146/31 were significantly elevated (all p < 0.05), flow-mediated vasodilatation increased 2.1%, 95% CI: (0.4%, 3.8%) and colony-forming units increased twofold, 95% CI: (1.7, 2.3) after 4 weeks of treatment with darbepoetin alfa. Subjects with diabetes exhibited an increase in a subset of EPCs (CD133 + and 34 + , p < 0.01 and p = 0.06, respectively), vasodilatation and proliferation. In conclusion, the administration of darbepoetin alfa for 4 weeks increased a subset of EPCs, improved endothelial function and increased cell proliferation, including those with diabetes, which is consistent with a favorable improvement in vascular health.

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Peripheral Arterial Disease

Cited by 58 publications

References 74 publications

Detection of Peripheral Artery Disease by Duplex Ultrasonography among Hemodialysis Patients

Detection of Peripheral Artery Disease by Duplex Ultrasonography among Hemodialysis Patients

Evaluation of Skin Microcirculation during Hemodialysis

Effect of darbepoetin alfa on endothelial progenitor cells and vascular reactivity in chronic kidney disease

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