title: Assessment of peripheral arterial disease of lower limbs with ultrasonography and ankle brachial index at the initiation of hemodialysis.
abstract: OBJECTIVE
  Peripheral arterial disease (PAD) of the lower limbs carries high risks of leg amputation, quality of life deterioration, and death in hemodialysis (HD) patients. However, the frequency of PAD at the initiation of HD has not been adequately documented. In addition, the applicability of ultrasonography to diagnosing PAD is not yet clear in HD patients.
  
  
  METHODS
  Twenty-seven patients within three months after HD initiation were enrolled. Ultrasonography was performed regardless of ischemic symptoms. Significant stenosis or obstruction of lower limb arteries on ultrasonography was diagnosed as PAD.
  
  
  RESULTS
  Sixteen of the 27 (59.3%) showed PAD on echography. On the other hand, only six of the 27 (22.2%) had an ABI < 0.9. Sixteen patients had a total of 37 lesions revealed by ultrasonography, and the average number of PAD lesions was 2.3 per patient. The numbers of PAD lesions on ultrasonography were as follows: iliac artery, 7; femoral-popliteal artery, 15; and infra-popliteal artery, 15. The ABI was 0.95 +/- 0.29 in PAD and 1.23 +/- 0.13 in non-PAD patients (p = 0.005).
  
  
  CONCLUSIONS
  A high prevalence of PAD at HD initiation was demonstrated. PAD may be missed using only the ABI (ankle brachial index). Ultrasonography is a reliable and non-invasive examination for detecting PAD.
authors.affiliation: Department of Internal Medicine, Suzuran Hospital, Suzurandai-Nishimachi, Kita-ku, Kobe-city, Hyogo, Japan. keisukekitaura@yahoo.co.jp
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kitaura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kida
authors.forename: Keizou
authors.initials: K
authors.lastname: Harima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006435:Renal Dialysis; D013997:Time Factors; D014463:Ultrasonography