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

Abstract

Abstract Background Peripheral 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. Methods We 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. Results The 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. Conclusion Measurement 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.

Keywords

• Peripheral artery disease (PAD)
• Hemodialysis (HD)
• Skin perfusion pressure (SPP)
• Ankle-brachial pressure index (ABI)