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Prediction of Development of Critical Limb Ischemia in Hemodialysis Patients
Author(s) -
Yoshikawa Hisao,
Iijima Raisuke,
Hashimoto Go,
Hara Hidehiko,
Omae Kiyotsugu,
Yoshikawa Yumiko,
Suzuki Makoto,
Nakamura Masato,
Sugi Kaoru,
Yoshikawa Masao
Publication year - 2015
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.12287
Subject(s) - medicine , critical limb ischemia , asymptomatic , logistic regression , incidence (geometry) , hemodialysis , risk factor , odds ratio , proportional hazards model , cardiology , diabetes mellitus , surgery , arterial disease , vascular disease , physics , optics , endocrinology
Hemodialysis ( HD ) patients with critical limb ischemia ( CLI ) suffer chronic inflammation and repeated infection, require intervention, and may have a protracted hospital stay. Therefore, early prediction is particularly important for management of CLI in patients with suspected peripheral artery disease. The purpose of this study is to develop a simple score for predicting the incidence of CLI in HD patients with suspected peripheral artery disease. The subjects were 139 asymptomatic patients receiving maintenance HD and with ABI <1.0. Multivariate logistic regression analysis was used to identify factors associated with development of CLI . These factors were subsequently weighted and integrated into a scoring system for the prediction of onset of CLI . Twenty‐five patients had onset of CLI . Five factors selected from the multivariate model were weighted proportionally using their respective odds ratio ( OR ) for incidence of CLI (history of cerebral vascular disease, OR 6.42 [3 points]; diabetes, OR 3.92 [2 points]; hypoesthesia, OR 4.21 [2 points]; left ventricular ejection fraction <50%, OR 3.89 [2 points]; serum albumin <3.5 g/dL, OR 4.39 [2 points]). Three strata of risk were defined (low risk, 0 to 3 points; intermediate risk, 4 to 6 points; and high risk 7 to 11 points) with excellent prognostic accuracy for progression to CLI using the K aplan– M eier method. Five factors were identified that increased the risk of progression to CLI in HD patients with suspected peripheral artery disease. A combination of those factors permitted establishment of three risk strata for accurate prediction of onset of CLI .