Abstract: FR-PO869

Screening for Peripheral Vascular Disease in Hemodialysis Patients by Measurement of Skin Perfusion Pressure

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Shariff, Saad Mohammed, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Albalas, Alian, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Almehmi, Ammar, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Narasimha Krishna, Vinay, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Lee, Timmy C., University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Abdel Aal, Ahmed Kamel, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Allon, Michael, University of Alabama at Birmingham, Birmingham, Alabama, United States
Background

Peripheral vascular disease (PVD) is common in hemodialysis patients, but the optimal noninvasive screening test is unclear. Ankle Brachial Index (ABI) is the most commonly used test, but its accuracy in ESRD patients is limited by medial calcific sclerosis. Skin perfusion pressure (SPP) in the feet may be a more accurate measure of the severity of PAD, but its use in hemodialysis patients has not been evaluated. An SPP less than 50 mm Hg indicates significant PVD. We analyzed the association of SPP with clinical characteristics of these patients.

Methods

We studied 78 chronic hemodialysis patients. After administration of a brief screening questionnaire and physical examination of the lower extremities, SPP was measured in both lower extremities immediately before a dialysis session. We analyzed the association of SPP (the lower value between the 2 extremities) and individual clinical characteristics.

Results

Among the 78 study patients, 51% had diabetes, and 10% had a history of a lower extremity amputation. Seven patients (9%) had an SPP < 50 mm Hg. Among patients with a history of lower extremity amputation, the SPP in the remaining lower extremity was significantly lower than that measured in patients without prior amputation (p=0.01). There was no significant association of SPP with patient age, gender, diabetes, smoking history, history of stroke, claudication or LDL cholesterol (Table).

Conclusion

Of all the clinical risk factors evaluated, only a history of lower extremity amputation was significantly associated with a lower SPP. We are currently following these patients prospectively to determine the predictive value of SPP for future lower extremity ischemia.

Skin perfusion Pressure measurement in Hemodialysis patients (N=78)
 Skin Perfusion Pressure (mm Hg), Mean ± SEp- Value
Patient VariableYesNo 
Age >= 65 yr (n=25)78 ± 583 ± 40.44
Male (n=37)82 ± 480 ± 40.71
Diabetes (n=40)82 ± 481 ± 40.85
Hx of Amputation (n=8)59 ± 884 ± 30.01
Ever Smoked (n=37)84 ± 479 ± 50.43
Hx CVA83 ± 1781 ± 30.70
Claudication (n=12)76 ± 682 ± 30.46
Excercise? (n=25)83 ± 580 ± 40.69
LDL >= 100 (n=14)90 ± 881 ± 50.35