TY - JOUR
T1 - Low plantar skin perfusion pressure predicts long-term atherosclerotic vascular events and mortality in maintenance haemodialysis patients
AU - Hiratsuka, Maki
AU - Koyama, Katsushi
AU - Takahashi, Hiroshi
AU - Kasugai, Takahisa
AU - Hagita, Junichiro
AU - Kondo, Akihito
AU - Koike, Kiyomi
AU - Hamano, Takayuki
N1 - Funding Information:
The authors are grateful to all the medical staff and patients who participated in this study. Part of the illustration in the graphical abstract was provided by Kaneka Medix corporation.
PY - 2020/11
Y1 - 2020/11
N2 - Background and aims: End-stage renal disease is associated with an increased risk of atherosclerotic vascular disease (AVD). We investigated whether low plantar skin perfusion pressure (SPP), a useful indicator of peripheral arterial disease (PAD), predicts systemic AVD events and mortality in outpatients undergoing maintenance haemodialysis (HD). Methods: A total of 206 HD patients were enrolled and followed for 5 years. They were divided into 3 groups according to measured SPP: group 1 (G1), SPP >70 mmHg (n = 123); G2, SPP 50–70 mmHg (n = 61); and G3, SPP <50 mmHg (n = 22). Results: During the follow-up period (median, 4.2 years), 56 AVD events (27.2%) and 68 deaths (33.0%) occurred. In G1, G2, and G3, the event-free survival rates were 74%, 55% and 19%, respectively, for AVD events (p < 0.01) and 73%, 54% and 26%, respectively, for mortality (p < 0.01). A Cox multivariate analysis showed that lower SPP was an independent predictor for AVD events [hazard ratio (HR) 3.12, 95% confidence interval (CI) 1.45–6.77, p < 0.01 for G3 vs. G1] and mortality (HR 3.06, 95% CI 1.57–5.98, p < 0.01 for G3 vs. G1). Furthermore, the addition of the SPP value to a model with established risk factors improved the predictability of increasing the net reclassification improvement (NRI; 0.463, p < 0.01) and integrated discrimination improvement (IDI; 0.039, p < 0.01) for AVD events. Similar results were obtained for mortality. Conclusions: Low plantar SPP can stratify risk and improve the predictability of both systemic AVD events and mortality in the maintenance HD population.
AB - Background and aims: End-stage renal disease is associated with an increased risk of atherosclerotic vascular disease (AVD). We investigated whether low plantar skin perfusion pressure (SPP), a useful indicator of peripheral arterial disease (PAD), predicts systemic AVD events and mortality in outpatients undergoing maintenance haemodialysis (HD). Methods: A total of 206 HD patients were enrolled and followed for 5 years. They were divided into 3 groups according to measured SPP: group 1 (G1), SPP >70 mmHg (n = 123); G2, SPP 50–70 mmHg (n = 61); and G3, SPP <50 mmHg (n = 22). Results: During the follow-up period (median, 4.2 years), 56 AVD events (27.2%) and 68 deaths (33.0%) occurred. In G1, G2, and G3, the event-free survival rates were 74%, 55% and 19%, respectively, for AVD events (p < 0.01) and 73%, 54% and 26%, respectively, for mortality (p < 0.01). A Cox multivariate analysis showed that lower SPP was an independent predictor for AVD events [hazard ratio (HR) 3.12, 95% confidence interval (CI) 1.45–6.77, p < 0.01 for G3 vs. G1] and mortality (HR 3.06, 95% CI 1.57–5.98, p < 0.01 for G3 vs. G1). Furthermore, the addition of the SPP value to a model with established risk factors improved the predictability of increasing the net reclassification improvement (NRI; 0.463, p < 0.01) and integrated discrimination improvement (IDI; 0.039, p < 0.01) for AVD events. Similar results were obtained for mortality. Conclusions: Low plantar SPP can stratify risk and improve the predictability of both systemic AVD events and mortality in the maintenance HD population.
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U2 - 10.1016/j.atherosclerosis.2020.09.006
DO - 10.1016/j.atherosclerosis.2020.09.006
M3 - Article
C2 - 32977123
AN - SCOPUS:85091245693
VL - 312
SP - 66
EP - 71
JO - Atherosclerosis
JF - Atherosclerosis
SN - 0021-9150
ER -