scholarly journals Significance of nutrition in hemodialysis patients with peripheral arterial disease evaluated by skin perfusion pressure

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Maho Watanabe ◽  
Asami Fuji ◽  
Sayuri Tokushima ◽  
Keiko Uemoto ◽  
Masayo Ueno ◽  
...  
Keyword(s):  
Perfusion Pressure ◽  
Salt Intake ◽  
Risk Index ◽  
Multiple Logistic Regression Analysis ◽  
Transferrin Saturation ◽  
Interquartile Range ◽  
Receiver Operating Curve ◽  
Skin Perfusion ◽  
Nutritional Risk Index ◽  
Skin Perfusion Pressure

Abstract Background Peripheral artery disease (PAD) is a serious complication in hemodialysis (HD) patients. Low skin perfusion pressure (SPP) is a useful marker for detecting PAD. Malnutrition is an important cause of intractable complications. We examined the relationship between low SPP and various indicators of nutritional status. Methods A total of 120 patients on maintenance HD were enrolled for SPP measurement. SPP was measured at the soles of both feet during HD, and patients were divided into low SPP (L-SPP) and normal SPP (N-SPP) groups by 50 mmHg. The following values were determined by averaging four blood samples taken before SPP measurements every 3 months for one year: hemoglobin, total protein, albumin (Alb), total cholesterol, urea nitrogen, creatinine (Cr), potassium, calcium, phosphate, intact parathyroid hormone, iron (Fe), transferrin saturation (T-SAT), and C-reactive protein (CRP). We calculated the percent Cr production rate, dialysis index (Kt/V), normalized protein catabolic rate (nPCR), geriatric nutritional risk index (GNRI), and estimated salt intake using the required formulas. In addition, the age, body mass index, and presence of diabetes mellitus (DM) were compared between both groups along with all other measurements. Data were expressed as the mean ± standard deviation or median with interquartile range as appropriate. Differences in continuous variables between the two groups were analyzed by Student’s t-test or Wilcoxon’s rank-sum test, as appropriate. Multivariate logistic analysis and receiver operating curve (ROC) analysis were performed for significant variables. The results were expressed as odds ratios with respective 95% confidence intervals (CIs). Results The enrolled patients were 82 men and 38 women, with a mean age of 66.9 ± 13.3 years and HD duration of 4.76 (2.13–12.28) years (median interquartile range). Twenty patients belonged to the L-SPP group, suggesting PAD. Comparison between the L-SPP and N-SPP groups showed significant differences in age, Cr, Fe, T-SAT, CRP, nPCR, GNRI, DM, and estimated salt intake. When the GNRI, estimated salt intake, CRP, and DM were applied as independent variables for multiple logistic regression analysis, the GNRI (odds ratio: 0.857, 95% CI 0.781–0.941, p = 0.001), CRP (2.406, 1.051–3.980, p = 0.035), and DM (9.194, 2.497–33.853, p = 0.001) were found to be significant for L-SPP, and a cutoff level of 92.1 (sensitivity 80%, specificity 72%, AUC: 0.742, 95% CI 0.626–0.858, p = 0.001) in the GNRI obtained by ROC was consistent with the risk index in the elderly presented previously. Conclusions SPP measurement is an essential tool for detecting high-risk PAD in maintenance HD, which is affected by malnutrition, DM, and inflammation. The GNRI is important for the determination of malnutrition.

Skin perfusion pressure for predicting access-related hand ischemia following arteriovenous fistula surgery based on the brachial artery

2021 ◽  
pp. 112972982199398
Author(s):  
Miju Bae ◽  
Sung Woon Chung ◽  
Chung Won Lee ◽  
Up Huh ◽  
Moran Jin ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Sensitivity And Specificity ◽  
Brachial Artery ◽  
Perfusion Pressure ◽  
Characteristic Curve ◽  
Major Complication ◽  
Clinical Predictors ◽  
Skin Perfusion ◽  
Hand Ischemia ◽  
Skin Perfusion Pressure

Background: Access-related hand ischemia (ARHI) is a major complication of arteriovenous fistula (AVF). This study aimed to assess the predictive efficacy of skin perfusion pressure (SPP) measurement for ARHI by examining the relationship between SPP and ARHI development and progression after AVF surgery. Methods: Twenty-five patients (16 men and 9 women) who underwent AVF surgery based on the brachial artery between January 2018 and December 2018 were included. The pre- and postoperative SPP values were measured on the day of surgery. ARHI occurrence and severity were measured within 3 days and at 6 months after surgery. Receiver operating characteristic curve analysis was used to evaluate the prediction model of ARHI, and the cutoff points for the calculated coefficients were determined. Results: There was a significant correlation between the occurrence of immediate ARHI and the SPP gradient ( p = 0.024). An SPP gradient value >50 mmHg had sensitivity and specificity values of 53.85% and 91.67%, respectively, in predicting the occurrence of immediate ARHI. A postoperative SPP <48 mmHg was significantly correlated with the occurrence of 6-month ARHI ( p = 0.005), with sensitivity and specificity values of 71.43% and 83.33%, respectively. Conclusion: The SPP gradient and postoperative SPP values may be effective clinical predictors of ARHI occurring immediately and 6 months after surgery, respectively, with high specificity. These findings could allow clinicians to diagnose and begin early interventions to help prevent ischemic tissue damage in hemodialysis patients following AVF surgery.

scholarly journals Methods and Nutritional Interventions to Improve the Nutritional Status of Dialysis Patients in JAPAN—A Narrative Review

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1390
Author(s):  
Yoshihiko Kanno ◽  
Eiichiro Kanda ◽  
Akihiko Kato
Keyword(s):  
Medical Staff ◽  
Salt Intake ◽  
Risk Index ◽  
Nutritional Risk ◽  
Registered Dietitians ◽  
Dialysis Therapy ◽  
Protein Energy Wasting ◽  
Nutritional Interventions ◽  
Protein Energy ◽  
Nutritional Risk Index

Patients receiving dialysis therapy often have frailty, protein energy wasting, and sarcopenia. However, medical staff in Japan, except for registered dietitians, do not receive training in nutritional management at school or on the job. Moreover, registered dietitians work separately from patients and medical staff even inside a hospital, and there are many medical institutions that do not have registered dietitians. In such institutions, medical staff are required to manage patients’ nutritional disorders without assistance from a specialist. Recent studies have shown that salt intake should not be restricted under conditions of low nutrition in frail subjects or those undergoing dialysis, and protein consumption should be targeted at 0.9 to 1.2 g/kg/day. The Japanese Society of Dialysis Therapy suggests that the Nutritional Risk Index-Japanese Hemodialysis (NRI-JH) is a useful tool to screen for older patients with malnutrition.

scholarly journals Ischaemic wound complications in above-knee amputations in relation to the skin perfusion pressure

1980 ◽  
Vol 4 (2) ◽  
pp. 81-86 ◽  
Author(s):  
P. Holstein
Keyword(s):  
Complication Rate ◽  
Perfusion Pressure ◽  
Wound Complication ◽  
External Pressure ◽  
Wound Complications ◽  
Local Skin ◽  
Skin Perfusion ◽  
Skin Perfusion Pressure ◽  
The Difference

Healing of the stumps in 59 above-knee amputations was correlated with the local skin perfusion pressure (SPP) measured pre-operatively as the external pressure required to stop isotope washout using 131I-- or 125I--anti-pyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mmHg no fewer than 9 (82 per cent) suffered wound complications. Out of the 48 cases with an SPP above 30 mmHg severe wound complications occurred in only 4 cases (8 per cent). The difference in wound complication rate is highly significant (P<0.01). It is concluded that the SPP can be used to predict ischaemic wound complications in above-knee amputations as has previously been shown to be the case in below-knee amputations.

scholarly journals Measurement of Skin Perfusion Pressure in Hemodialyzed Patients: Association with Toe/Brachial Index

2008 ◽  
Vol 37 (11) ◽  
pp. 431-438 ◽  
Author(s):  
Masaru Shimazaki ◽  
Takayuki Matsuki ◽  
Kazuaki Yamauchi ◽  
Michihiro Iwata ◽  
Hiroshi Takahashi ◽  
...  
Keyword(s):  
Perfusion Pressure ◽  
Skin Perfusion ◽  
Skin Perfusion Pressure ◽  
Toe Brachial Index

Low plantar skin perfusion pressure predicts long-term atherosclerotic vascular events and mortality in maintenance haemodialysis patients

2020 ◽  
Vol 312 ◽  
pp. 66-71
Author(s):  
Maki Hiratsuka ◽  
Katsushi Koyama ◽  
Hiroshi Takahashi ◽  
Takahisa Kasugai ◽  
Junichiro Hagita ◽  
...  
Keyword(s):  
Perfusion Pressure ◽  
Vascular Events ◽  
Skin Perfusion ◽  
Maintenance Haemodialysis ◽  
Skin Perfusion Pressure

Changes in Skin Perfusion Pressure After Endovascular Treatment for Chronic Limb-Threatening Ischemia

2020 ◽  
pp. 152660282096393
Author(s):  
Shigeo Ichihashi ◽  
Mitsuyoshi Takahara ◽  
Naoki Fujimura ◽  
Tsuyoshi Shibata ◽  
Miki Fujii ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Perfusion Pressure ◽  
Peroneal Artery ◽  
Prospective Multicenter Study ◽  
Skin Perfusion ◽  
Posterior Tibial ◽  
Tibial Arteries ◽  
Skin Perfusion Pressure ◽  
Indirect Revascularization ◽  
Preoperative Factors

Purpose To assess skin perfusion pressure (SPP) changes after endovascular treatment (EVT) of patients with chronic limb-threatening ischemia (CLTI) and to explore preoperative factors that affect SPP changes. Materials and Methods This prospective, multicenter study recruited 147 patients (mean age 74 years; 99 men) with ischemic wounds at 6 vascular centers in Japan between July 2017 and December 2018. Over half of the patients (92, 63%) were diabetic, and 76 (52%) required dialysis. Sixty-four patients (43%) had WIfI (wound, ischemia, foot infection) wound grades of 2 or 3; 59 (40%) had foot infections. SPP was measured before and 1, 2, 7, and 30 days after EVT to establish inline flow to the ischemic foot based on the angiosome concept when feasible. The anterior and posterior tibial arteries and the peroneal artery were revascularized in 66 (45%), 50 (34%), and 30 (21%) patients, respectively. Results Both the dorsal and plantar SPPs at 1 or 2 days post-EVT were significantly higher than those at baseline (p<0.001), and both SPPs increased further at 1 month compared with those at 1 (p=0.001) or 2 days (p=0.006) post-EVT. SPP increases occurred on the dorsal and plantar surfaces of the foot regardless of the vessel revascularized. The SPP increase at 1 month after EVT was significantly lower in patients with foot infections than that in those without foot infections (p=0.003). Age, sex, diabetes, dialysis, wound severity, and direct revascularization did not affect the pattern of SPP change. Conclusion The SPP increased continuously up to 1 month after EVT, though the increase was smaller in patients with wound infections. The SPP on the dorsal and plantar surfaces increased, regardless of the vessel revascularized, which could justify indirect revascularization when direct revascularization is technically challenging.

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