title: Effects of the ankle-brachial blood pressure index and skin perfusion pressure on mortality in hemodialysis patients.
abstract: OBJECTIVE
  Clinically, the ankle-brachial blood pressure index (ABI) and skin perfusion pressure (SPP) are used to screen for subclinical peripheral artery disease. However, the association between the SPP and mortality in hemodialysis patients has not been previously reported. We investigated these factors and compared the ABI and SPP in patients receiving hemodialysis.
  
  
  METHODS
  A total of 102 patients receiving maintenance hemodialysis were enrolled in this study. The ABI was determined using an ABI-form (Colin, Japan). The SPP was measured using a SensiLase(TM) PAD3000 (Kaneka, Osaka, Japan).
  
  
  RESULTS
  The mean follow-up period was 3.2 ± 1.4 years. A multivariate Cox analysis identified a low ABI (p=0.019) and a low SPP (p=0.047) as being independent predictors of mortality. A receiver operating characteristic (ROC) analysis of the ABI revealed a cutoff point of 1.1 and an area under the curve (AUC) of 0.79, with a sensitivity of 90% and a specificity of 62%. A ROC analysis of the SPP revealed a cutoff point of 54.0 mmHg and an AUC of 0.71, with a sensitivity of 55% and a specificity of 84%.
  
  
  CONCLUSIONS
  Both low ABI and SPP values were found to be independent risk factors for mortality among hemodialysis patients. The cutoff point for ABI as a predictor of mortality was 1.1, while that for SPP was 54.0 mmHg.
authors.affiliation: Department of Clinical Engineering, Tokyo Women's Medical University, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Otani
authors.forename: Shigeru
authors.initials: S
authors.lastname: Otsubo
authors.forename: Naoki
authors.initials: N
authors.lastname: Kimata
authors.forename: Mari
authors.initials: M
authors.lastname: Takano
authors.forename: Takayuki
authors.initials: T
authors.lastname: Abe
authors.forename: Tomoki
authors.initials: T
authors.lastname: Okajima
authors.forename: Naoko
authors.initials: N
authors.lastname: Miwa
authors.forename: Ken
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000150:complications / Q000503:physiopathology; D016016:Proportional Hazards Models; D012372:ROC Curve; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000098:blood supply*