Effects of the Ankle-brachial Blood Pressure Index and Skin Perfusion Pressure on Mortality in Hemodialysis Patients

Yumi Otani; Shigeru Otsubo; Naoki Kimata; Mari Takano; Takayuki Abe; Tomoki Okajima; Naoko Miwa; Ken Tsuchiya; Kosaku Nitta; Takashi Akiba

doi:10.2169/internalmedicine.52.0410

ORIGINAL ARTICLES

Effects of the Ankle-brachial Blood Pressure Index and Skin Perfusion Pressure on Mortality in Hemodialysis Patients

Yumi Otani, Shigeru Otsubo, Naoki Kimata, Mari Takano, Takayuki Abe, Tomoki Okajima, Naoko Miwa, Ken Tsuchiya, Kosaku Nitta, Takashi Akiba

Author information

Yumi Otani
Department of Clinical Engineering, Tokyo Women's Medical University, Japan
Shigeru Otsubo
Department of Blood Purification, Sangenjaya Hospital, Japan
Department of Nursing, Faculty of Human Care, Tohto College of Health Sciences, Japan
Naoki Kimata
Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Japan
Mari Takano
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Japan
Takayuki Abe
Department of Clinical Engineering, Tokyo Women's Medical University, Japan
Tomoki Okajima
Department of Clinical Engineering, Tokyo Women's Medical University, Japan
Naoko Miwa
Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Japan
Ken Tsuchiya
Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Japan
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Japan
Kosaku Nitta
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Japan
Takashi Akiba
Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Japan

Keywords: ankle-brachial index, hemodialysis, peripheral artery disease, skin perfusion pressure

JOURNAL OPEN ACCESS

2013 Volume 52 Issue 21 Pages 2417-2421

DOI https://doi.org/10.2169/internalmedicine.52.0410

Details

Abstract

Objective Clinically, the ankle-brachial blood pressure index (ABI) and skin perfusion pressure (SPP) are used to screen for subclinical peripheral artery disease. However, the association between the SPP and mortality in hemodialysis patients has not been previously reported. We investigated these factors and compared the ABI and SPP in patients receiving hemodialysis.
Methods A total of 102 patients receiving maintenance hemodialysis were enrolled in this study. The ABI was determined using an ABI-form (Colin, Japan). The SPP was measured using a SensiLase^TM PAD3000 (Kaneka, Osaka, Japan).
Results The mean follow-up period was 3.2±1.4 years. A multivariate Cox analysis identified a low ABI (p=0.019) and a low SPP (p=0.047) as being independent predictors of mortality. A receiver operating characteristic (ROC) analysis of the ABI revealed a cutoff point of 1.1 and an area under the curve (AUC) of 0.79, with a sensitivity of 90% and a specificity of 62%. A ROC analysis of the SPP revealed a cutoff point of 54.0 mmHg and an AUC of 0.71, with a sensitivity of 55% and a specificity of 84%.
Conclusion Both low ABI and SPP values were found to be independent risk factors for mortality among hemodialysis patients. The cutoff point for ABI as a predictor of mortality was 1.1, while that for SPP was 54.0 mmHg.

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