Skin perfusion pressure predicts mortality in hemodialysis patients: Long term follow-up

Abstract

Background: Peripheral artery disease (PAD) is not only a serious complication but also a risk factor to predict prognosis in the patients with hemodialysis (HD). Ankle-brachial blood pressure index (ABI) has been widely used for detection of PAD. Skin perfusion pressure (SPP) was used for early detection of PAD by measurement of microcirculation of subcutaneous tissue. We studied the effectiveness of ABI and SPP to predict prognosis of HD patients. Methods: Both SPP and ABI were measured in 45 HD outpatients in Nagahara Hospital. The patients were followed with a mean observational period of 44.4 months to evaluate the association of ABI or SPP value with any-cause mortality. Results: The median ABI and SPP values in all patients were 1.15 and 70.0 mmHg, respectively, and the patients were classified into two groups with the median value used as the cutoff points. In Kaplan-Meier analysis, the lower SPP group showed significantly worse survival curve than the higher SPP group while there were no differences between ABI groups. Cox proportional hazards model demonstrated SPP values are independent and significant risk factors for mortality. Conclusions: These results suggest evaluation of PAD by SPP measurement is useful to predict prognosis of HD patients.