Peripheral Arterial Occlusive Disease Is More Prevalent in Patients With Hemodialysis: Comparison With the Findings of Multidetector-Row Computed Tomography

Okamoto, Koji; Oka, Machiko; Maesato, Kyoko; Ikee, Ryota; Mano, Tsutomu; Moriya, Hideshige; Ohtake, Takayasu; Kobayashi, Shuzo

doi:10.1053/j.ajkd.2006.04.075

Cited by 127 publications

(136 citation statements)

References 15 publications

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“…The relation between PAD and mortality persisted even after adjustment for age, gender, duration of dialysis, diabetes mellitus and smoking (OR, 1.575; 95% CI, 1.038-2.381; P = 0.033) [1]. These findings support the results of earlier studies showing that PAD is common in dialysis patients and that it is associated with increased cardiovascular morbidity and mortality rates in this population [2][3][4]. This Editorial discusses some additional aspects that may be of interest.…”

supporting

confidence: 85%

“…Thus, in dialysis patients, high vascular calcification scores on plain radiographs [7] or duplex ultrasonography of the lower limb arteries [17] may be more accurate predictors of PAD than the ABI. Due to the strong association between PAD and increased cardiovascular mortality rates in dialysis patients [1][2][3][4], the early detection of subclinical PAD in these patients is crucial. The early recognition of subclinical PAD will allow the timely initiation of preventive measures (e.g.…”

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confidence: 99%

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Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures

et al. 2011

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supporting

confidence: 85%

mentioning

confidence: 99%

Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures

et al. 2011

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“…1 For the evaluation of above the knee stenotic lesions, ABI is considered to be useful, but its sensitivity has been reported to be low in HD patients. 2 3 In this study, Ex-ABI in HD patients overcame this problem of ABI on screening for above the knee stenotic lesions by increasing the positive result rate and reducing the false-positive rate.…”

Section: Discussionmentioning

confidence: 99%

“…PAD in HD patients is characterized by diffuse stenotic lesions below the knee. However, one-third of HD patients with lesions below the knee also have stenotic lesions above the knee 1 and their presence accelerates progress to critical limb ischemia (CLI). Early detection of PAD is the most important factor for the management of CLI in HD patients and various examinations are performed for this purpose.…”

mentioning

confidence: 99%

“…Generally, skin perfusion pressure (SPP) is useful for the evaluation of microangiopathy below the knee or ankle. 1 On the other hand, anklebrachial pressure index (ABI) is widely used as a standard screening method for macroangiopathy above the knee. However, in HD patients, false negative results due to medial arterial calcification have been reported, which is problematic.…”

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confidence: 99%

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Exercise-Ankle Brachial Pressure Index with One-Minute Treadmill Walking in Patients on Maintenance Hemodialysis

Tsuyuki

Kohno

Ebine

et al. 2013

Annals of Vascular Diseases

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Background: The ankle-brachial pressure index (ABI) is widely used as a standard screening method for arterial occlusive lesion above the knee. However, the sensitivity of ABI is low in hemodialysis (HD) patients. Exercise stress (Ex-ABI) may reduce the false negative results. Patients and Methods: After measuring resting ABI and toe-brachial pressure index (TBI), ankle pressure and ABI immediately after walking (Post-AP, Post-ABI) were measured using one-minute treadmill walking in 52 lower limbs of 26 HD patients. The definition of peripheral arterial occlusive disease (PAD) required an ABI value of less than 0.90, TBI value of less than 0.60, and decrease of more than 15% of the Post-ABI value and 20 mmHg of Post-AP in Ex-ABI. Computed tomographic angiography (CTA) was performed in 32 lower limbs of 16 HD patients. PAD is defined as presence of stenosis of more than 75% in the case of lesions from an iliac artery to knee on CTA. Results: The accuracy of Ex-ABI (Sensitivity, 85.7%; Specificity, 77.7%) was higher than those of ABI (Sensitivity, 42.9%; Specificity, 83.3%) or TBI (Sensitivity, 78.6%; Specificity, 61.1%). Conclusion: Ex-ABI with one-minute treadmill walking is the most useful tool for the screening of arterial occlusive lesions above the knee in maintenance HD patients.

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Toe-brachial index and toe systolic blood pressure for the diagnosis of peripheral arterial disease

Tehan,

Mills,

Leask

et al. 2024

Cochrane Database of Systematic Reviews

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Background Peripheral arterial disease (PAD) of the lower limbs is caused by atherosclerotic occlusive disease in which narrowing of arteries reduces blood flow to the lower limbs. PAD is common; it is estimated to affect 236 million individuals worldwide. Advanced age, smoking, hypertension, diabetes and concomitant cardiovascular disease are common factors associated with increased risk of PAD. Complications of PAD can include claudication pain, rest pain, wounds, gangrene, amputation and increased cardiovascular morbidity and mortality. It is therefore clinically important to use diagnostic tests that accurately identify PAD. Accurate and timely detection of PAD allows clinicians to implement appropriate risk management strategies to prevent complications, slow progression or intervene when indicated. Toe‐brachial index (TBI) and toe systolic blood pressure (TSBP) are amongst a suite of non‐invasive bedside tests used to detect PAD. Both TBI and TSBP are commonly utilised by a variety of clinicians in different settings, therefore a systematic review and meta‐analysis of their diagnostic accuracy is warranted and highly relevant to inform clinical practice. Objectives To (1) estimate the accuracy of TSBP and TBI for the diagnosis of PAD in the lower extremities at different cut‐off values for test positivity in populations at risk of PAD, and (2) compare the accuracy of TBI and TSBP for the diagnosis of PAD in the lower extremities. Secondary objectives were to investigate several possible sources of heterogeneity in test accuracy, including the following: patient group tested (people with type 1 or type 2 diabetes, people with renal disease and general population), type of equipment used, positivity threshold and type of reference standard. Search methods The Cochrane Vascular Information Specialist searched the MEDLINE, Embase, CINAHL, Web of Science, LILACS, Zetoc and DARE databases and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 27 February 2024. Selection criteria We included diagnostic case‐control, cross‐sectional, prospective and retrospective studies in which all participants had either a TSBP or TBI measurement plus a validated method of vascular diagnostic imaging for PAD. We needed to be able to cross‐tabulate (2 x 2 table) results of the index test and the reference standard to include a study. To be included, study populations had to be adults aged 18 years and over. We included studies of symptomatic and asymptomatic participants. Studies had to use TSBP and TBI (also called toe‐brachial pressure index (TBPI)), either individually, or in addition to other non‐invasive tests as index tests to diagnose PAD in individuals with suspected disease. We included data collected by photoplethysmography, laser Doppler, continuous wave Doppler, sphygmomanometers (both manual and aneroid) and manu...

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Peripheral Arterial Occlusive Disease Is More Prevalent in Patients With Hemodialysis: Comparison With the Findings of Multidetector-Row Computed Tomography

Cited by 127 publications

References 15 publications

Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures

Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures

Exercise-Ankle Brachial Pressure Index with One-Minute Treadmill Walking in Patients on Maintenance Hemodialysis

Toe-brachial index and toe systolic blood pressure for the diagnosis of peripheral arterial disease

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