Ankle brachial index independently predicts early kidney disease.
BACKGROUND
Chronic kidney disease (CKD) and atherosclerotic cardiovascular disease (CVD) are often both present in selected populations. The independent association of early renal disease and atherosclerosis has not been studied in the general population. We hypothesized that the presence of low ankle brachial index (ABI), a surrogate measure of atherosclerotic cardiovascular disease, is associated with a low estimated glomerular filtration rate (GFR).


METHODS
The study population consisted of 14,917 middle-aged black and white men and women from the Atherosclerosis Risk in Communities (ARIC) Study. An ABI<0.90 was defined as the exposure, and an estimated GFR<90 mL/min/1.73 m2 was defined as the outcome. Logistic regression analysis was performed cross-sectionally using an ABI of 1.00-1.19 as the reference, and was adjusted for the usual cardiovascular risk factors.


RESULTS
The presence of an ABI<0.90 was associated with an increased odds of having an estimated GFR<90 (OR: 1.80; 95% C.I.: 1.40-2.32) compared to the reference group. After adjustment, an ABI<0.90 remained significant, and increased the odds of having an estimated GFR<90 (OR: 1.54; 95% C.I.: 1.17-2.04) compared to the reference group. The odds ratio for GFR<90 was higher among African Americans than Whites, 1.88 versus 1.36 respectively.


CONCLUSIONS
This study gives support to the independent association of early CKD and atherosclerotic CVD. The relationship appears to be stronger among African Americans than among Whites. It will be necessary to investigate this observation more fully with prospective studies given the rising incidence of CKD.
University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7155, USA. sagar@med.unc.edu
Abhijit V
AV
Kshirsagar
Josef
J
Coresh
Frederick
F
Brancati
Romulo E
RE
Colindres
D001741:Black or African American; D000842:Ankle; D001161:Arteriosclerosis / Q000209:etiology; D001794:Blood Pressure; D001916:Brachial Artery / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D044465:White People