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

Peripheral arterial disease (PAD) is common in hemodialysis patients and predicts a poor prognosis. We conducted a prospective cohort study to identify risk factors for PAD including skin perfusion pressure (SPP) in hemodialysis patients. The cohort included 373 hemodialysis patients among 548 patients who received hemodialysis at Oyokyo Kidney Research Institute, Hirosaki, Japan from August 2008 to December 2010. The endpoints were lower limb survival (peripheral angioplasty or amputation events) and overall survival of 2 years. Our results showed that <70 mmHg SPP was a poor prognosis for the lower limb survival and overall survival. We also identified age, history of cardiovascular disease, presence of diabetes mellitus, smoking history, and SPP < 70 mmHg as independent risk factors for lower limb survival and overall survival. Then, we constructed risk criteria using the significantly independent risk factors. We can clearly stratify lower limb survival and overall survival of the hemodialysis patients into 3 groups. Although the observation period is short, we conclude that SPP value has the potential to be a risk factor that predicts both lower limb survival and the prognosis of hemodialysis patients.

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Examination of a skin perfusion pressure measurement method for the detection of lower limb peripheral arterial disease in hemodialysis patients

Nihon Toseki Igakkai Zasshi ◽

10.4009/jsdt.54.123 ◽

2021 ◽

Vol 54 (3) ◽

pp. 123-129

Author(s):

Takuya Kamino ◽

Mayumi Shibuya ◽

Yuki Ohmae ◽

Shigeru Nishikawa ◽

Kiyoshi Tsurusaki ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Pressure Measurement ◽

Lower Limb ◽

Measurement Method ◽

Perfusion Pressure ◽

Arterial Disease ◽

Hemodialysis Patients ◽

Skin Perfusion ◽

Skin Perfusion Pressure ◽

Peripheral Arterial

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Long-term trajectories of SARS-CoV-2 neutralizing antibodies and predictive value of first dose vaccination-induced IgG-antibodies in hemodialysis patients

International Urology and Nephrology ◽

10.1007/s11255-021-03076-2 ◽

2021 ◽

Author(s):

F. P. Tillmann ◽

H. Still ◽

Philipp von Landenberg

Keyword(s):

Predictive Value ◽

Neutralizing Antibodies ◽

Hemodialysis Patients ◽

Rapid Decline ◽

Igg Antibodies ◽

Neutralizing Capacity ◽

Long Term Follow Up ◽

Antibody Titers

Abstract Purpose The predictive value of antibody titers after the first SARS-CoV-2 vaccination and long-term trajectories of antibody titers in hemodialysis patients are unknown. Methods SARS-CoV-2 IgG antibodies and their neutralizing effect six weeks after the first and second vaccination were analysed in 30 hemodialysis patients. IgG titers served to classify participants as responders or non-responders and to calculate sensitivity, specificity, and accuracy. Associations between potential risk factors and post-vaccine non-response were analysed by Mann–Whitney-U test and Chi-Squared test. Long-term follow-up analysis (ANOVA) on the evolution of neutralizing IgG-titers was performed in 24 participants 94 and 135 days after the second immunization. Results IgG antibodies ≥ 1 AU/L (mean 9 ± 20 AU/L) after the first dose were found in 20 patients (66.7%). After the second dose only two participants (6.7%) remained sero-negative and 16.6% showed neutralizing levels below 30%, whereas 25 patients showed IgG antibodies with the high neutralizing activity of 86 ± 18%. Positive IgG antibodies 6 weeks after the first vaccination predicted vaccination effectiveness after two cycles with a specificity of 100%, sensitivity of 76%, and accuracy of 87%. Even low-dose immunosuppressive therapy increased the relative risk for non-response after the first and second dose 1.9 (95% CI 0.8–4.6) and 4.9 (95% CI 1.0–23.8) times, respectively. Over a period of about 4.5 months IgG titers slowly declined by 51% from baseline or by 0.45 AU/mL per day, respectively. Conclusion Two cycles of SARS-CoV-2 vaccination-induced high seroconversion rates comparable to the general population. Immunosuppressive medication is a major risk factor for vaccination non-response. Mounted IgG antibodies showed a high neutralizing capacity as evidence of protective effectiveness. IgG antibodies after the first dose may serve to predict later vaccination outcome. Patients on dialysis display a more rapid decline in antibody titers on long-term follow-up compared to healthy controls.

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