The laser Doppler skin perfusion pressure (SPP) testing is expected to be beneficial for assessment of lower extremity peripheral artery disease (PAD) in patients on hemodialysis (HD). However, it is inconsistent at what timing SPP should be measured in relation to HD procedure. We measured each SPP value before, during, and after HD in 12 limbs of 6 patients without diabetes or PAD. There were not significant differences among mean SPP values, which were 90mmHg (SD=15), 83mmHg (SD=10), 89mmHg (SD=12), and 86mmHg (SD=16) at predialysis, 2-hr, 3-hr, and postdialysis, respectively. Results of this study suggest that compensatory responses to volume loss could contribute to maintain cutaneous perfusion during ultrafiltration of fluid. The laser Doppler SPP examination is likely to be useful even during or after HD. However, it seems that the SPP evaluation during or after HD requires carefulness. Introduction Peripheral arterial disease (PAD) is common in patients with end-stage renal disease. The assessment of arteriosclerotic complication is of particular important and interest for patients on hemodialysis (HD) (1,2,3,4). However, ankle/brachial index (ABI) is not always a good indicator in patients with end-stage renal disease (5). The laser Doppler skin perfusion pressure (SPP) testing is a microcirculatory measure and reflects perfusion at the level of the skin. The applicability of SPP has become wider (6,7,8), and is expected to be beneficial for assessment of lower extremity PAD in patients on HD (9,10). The timing of SPP measurement in HD patients varies with each institution. Briefly, SPP value is conventionally measured before HD or at non-dialysis day. However, in some institutions, SPP measurement was performed after or during HD. Ultrafiltration dialysis is accompanied by fluid removal and may develop a reduction in blood pressure during HD. Reduced plasma refilling and peripheral vasoconstriction as a result of volume loss would lead to a reduced SPP. It is quite a problem that there is no opinion as for the timing of SPP measurement. I reported the variation of SPP values associated with HD time-course. Methods This study enrolled 6 outpatients with stable disease conditions, who had been treated with ordinary chronic regular HD more than for 4 hours. All patients were dialyzed three times a week. Preceding this study, ABI was evaluated with form PWV/ABI (Nippon Colin, Komaki, Japan) and toe/brachial index (TBI) was evaluated with VaSera VS-1000 (Fukuda Denshi, Tokyo, Japan). Patients with diabetes mellitus and PAD were excluded. The SPP test using SensiLase PAD3000 (Kaneka, Osaka, Japan) was started to perform at least fifteen minutes after patient lay on the bed. SPP was measured with a laser sensor assembly (LSA) attached on the patient’s foot and with a pressure cuff wrapped around both the foot and LSA. Systolic blood pressure (SBP), pulse rate (PR) and SPP were measured at four time points, predialysis; 2-hr and 3-hr later the initiation of HD; and postdialysis. Continuous monitoring of % blood volume reduction was evaluated by CRIT-LINE III (Hemametrics, Salt Lake City, UT, USA) during HD session. The study was conducted according to the declaration of Helsinki. It was also fully explained to all patients, especially focusing on the purpose of the study and precise procedures, before enrollment. All patients agreed to participate in the research and gave oral informed consent.Data are given as means and standard deviations. Changes in ultrafiltration of fluid, % blood volume reduction, SPP, SBP, and PR were analyzed using repeated measures analysis of variance. Statistical significance was defined at the level of p<0.05. Results The participants in this study were 5 women and 1 man. The mean age was 64.7 (SD=14.4, range 47-83) years, and the mean duration of dialysis was 85.5 (SD=63.2, range 27-182) months. Their primary renal diseases were chronic glomerulonephritis in 4 cases, polycystic kidney disease i
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