Predictive factors for skin perfusion pressure on plantar skin and diabetes complications in hemodialysis patients

Abstract

We investigated parameters related to skin perfusion pressure (SPP) on the plantar skin of hemodialysis (HD) patients and their correlation with diabetes complications. The plantar SPP measured on 348 toes of HD patients was 77.0 ± 17.6 mmHg, and the bilateral mean was 76.4 ± 17.6 mmHg, indicating close to 100% concordance for all data. Multiple regression analysis indicated that age and both systolic and diastolic blood pressures were independent predictive factors. We therefore assume that the calcification of blood vessels and resultant age-related arteriosclerosis affect this process. When performing a clinical assessment of plantar SPP, it appears necessary to consider variations in blood pressure due to the timing of measurements. However, HbA1c and glycoalbumin levels exhibited a significant negative correlation. The diabetic plantar SPP was 73.4 ± 15.2 mmHg, which was significantly lower than the nondiabetic plantar SPP of 79.7 ± 17.5 mmHg (p < 0.05), and in severe cases such as those of patients who had undergone unilateral leg amputation, the plantar SPP was significantly lower, at 34.5 ± 21.3 mmHg (p < 0.01). The results of this study suggest that complications caused by microangiopathy in diabetic HD patients contribute to decreased plantar SPPs.