Prognostic significance of ankle-brachial index, brachial-ankle pulse wave velocity, flow-mediated dilation, and nitroglycerin-mediated dilation in end-stage renal disease.
BACKGROUND
Identifying patients at high risk of cardiovascular disease is important in managing patients undergoing hemodialysis.


METHODS
We evaluated a series of prognostic values: flow-mediated dilation (FMD) and nitrogen-mediated dilation (NMD), an index of endothelium-dependent and endothelium-independent function, respectively, ankle-brachial index (ABI), and brachial-ankle pulse wave velocity (baPWV) in patients undergoing chronic hemodialysis.


RESULTS
A cohort of 199 patients was studied. At entry, these values were examined and the prognostic significances were investigated. In estimating the significance of baPWV, patients with ABI <0.9 were excluded. During the follow-up period, 24 deaths occurred including 14 cardiovascular and 10 noncardiovascular fatal events. Overall, the survival rates were significantly lower in the low ABI than in the high ABI group, but the survival rates were not significantly different between the high and low FMD, NMD, or baPWV groups. Cardiovascular survival rates were significantly lower in the low ABI than in the high ABI group, and in the high baPWV than in the low baPWV group. The survival rates were not significantly different between the high and low FMD or NMD groups.


CONCLUSIONS
Screening hemodialysis patients by means of ABI and baPWV but not FMD or NMD provides complementary information in identifying a high-risk population in these patients.
Morimoto
Satoshi
S
Second Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan. morimots@hirakata.kmu.ac.jp
Yurugi
Takatomi
T
Aota
Yasuko
Y
Sakuma
Takao
T
Jo
Fusakazu
F
Nishikawa
Mitsushige
M
Iwasaka
Toshiji
T
Maki
Kei
K
D000368:Aged; D000842:Ankle / Q000098:blood supply; D055109:Ankle Brachial Index; D015331:Cohort Studies; D004727:Endothelium / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000737:chemistry; D005996:Nitroglycerin / Q000737:chemistry*; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods*; D014665:Vasodilator Agents / Q000737:chemistry
D014665:Vasodilator Agents; D005996:Nitroglycerin; D009584:Nitrogen