Skin Perfusion Pressure and the Prevalence of Atherothrombosis in Hemodialysis Patients

Abstract

End-stage renal disease is associated with atherothrombosis (ATIS), which, in turn, can promote peripheral arterial occlusive disease (PAOD), coronary artery disease (CAD), and/or cerebrovascular disease (CVD). The aim of this study was to determine whether low plantar skin perfusion pressure (SPP) was related to ATIS among 122 patients receiving maintenance hemodialysis (HD) from March to November 2013 at our outpatient facility. We routinely measured SPP and used the value for analysis. In addition, we retrospectively evaluated the prevalence of ATIS with patients categorized to CAD, CVD, or PAOD groups. Of the 122 outpatients, ATIS was diagnosed in about half (N = 60, 49.2% vs. 62, 50.8%; average SPP, 56.6 vs. 72.9 mm Hg, respectively). These data show that SPP was significantly lower in patients with ATIS (difference, 16.3 mm Hg; P < 0.001) and there was a negative relationship between average SPPs and past history of ATIS complications. When the patients were stratified by the presence of diabetes mellitus, this trend was stronger. Particularly, receiver operating characteristic analysis of HD patients with diabetes revealed a cutoff point of 53.0 mm Hg and an area under the curve value of 0.84, with a sensitivity of 77.0% and specificity of 91.3%. Therefore, we concluded that SPP enables the evaluation of not only local PAOD, but also systemic ATIS. Moreover, we found that a cutoff point of 53.0 mm Hg was useful for detection of ATIS in HD patients.

Skin perfusion pressure as a predictor of ischemic wound healing potential (Review)

“…In recent years, the majority of research on SPP has been conducted using laser Doppler (7). In addition to its use in the diagnosis of critical limb ischemia (CLI) (20), in evaluating the severity of ischemia (21)(22)(23)(24), in the selection of the amputation plane (25), and in predicting wound healing, SPP is also used to evaluate the therapeutic efficacy of arterial revascularization surgery (26,27), endovascular therapy (28), and medicines used for the treatment of peripheral artery disease (PAD) and CLI (29,30). In a previous study, Watanabe et al (31) revised the laser Doppler technology, and SPP was measured using a thermostatic heating probe.…”

Carotid Artery Stenosis as a Part of Atherosclerosis

“…13,21,22) Since such diseases that cause thrombosis based on atherosclerosis show a common pathogenic pattern, a pathological concept called atherothrombosis (ATIS) has been proposed recently. 23,24) In addition, the presence of carotid artery plaque and intima-media thickness (IMT) of the carotid artery is recognized as surrogate markers of atherosclerosis, and CS has been reported to be often complicated by other atherosclerotic diseases. [25][26][27] Hertzer et al 12) performed CAG in 506 patients with extracranial CS and reported that the coronary artery was normal in only 7% and markedly stenosed in 35%.…”

A new polymethylmetacrylate membrane improves the membrane adhesion of blood components and clinical efficacy

“…In this study, we evaluated peripheral circulation by SPP which is a method measuring non-invasively dermal microcirculation by using Laser Doppler imaging-based methods because there are many reports describing them being useful to evaluate peripheral circulation disturbance such as lower limb ischemia in hemodialysis patients [7,8]. Evaluation of the SPP suggested that peripheral circulation was more stable during dialysis with NF (Fig.…”