Significant correlation between ankle-brachial index and vascular access failure in hemodialysis patients.
OBJECTIVE
Vascular access failure (VAF) is associated with increased morbidity and mortality in hemodialysis patients. The most common cause of VAF is stenosis at the arteriovenous anastomosis because of abnormal neointimal proliferation and extracellular matrix deposition. These two changes are also observed in the classic atheroma, which means atherosclerotic lesions and venous stenosis in VAF may share some similar pathogenic mechanisms. The ankle-brachial index (ABI) is a reliable marker for atherosclerosis. The aim of this study was to evaluate the relationship between ABI <0.9 and VAF.


METHODS
All routine hemodialysis patients in one regional hospital were included except for six patients refusing ABI examinations and four patients with atrial fibrillation. Finally, 225 patients formed our study group. The study subjects were observed from arteriovenous access creation until the first episode of VAF. The mean observation period was 42.2 +/- 42.8 mo. The relative VAF risk was analyzed by Cox-regression methods with adjustments for demographic and comorbid conditions.


RESULTS
VAF episodes were recorded in 111 patients. In multivariate analysis, ABI <0.9 (hazard ratio, 1.893; P = 0.039), vascular access type of arteriovenous graft (P = 0.004), and serum triglyceride level (P = 0.043) were positively associated with VAF, and serum parathyroid hormone level (P = 0.043) was negatively associated with VAF.


CONCLUSIONS
Our findings show that ABI <0.9 is significantly correlated with increased VAF. Screening hemodialysis patients by means of ABI may help to identify a high-risk group for VAF.
Chen
Szu-Chia
SC
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Chang
Jer-Ming
JM
Hwang
Shang-Jyh
SJ
Tsai
Jer-Chia
JC
Wang
Chuan-Sheng
CS
Mai
Hsiu-Chin
HC
Lin
Feng-Hsien
FH
Su
Ho-Ming
HM
Chen
Hung-Chun
HC
D000368:Aged; D000842:Ankle / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology*; D003251:Constriction, Pathologic; D003430:Cross-Sectional Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency