Ankle brachial index as a predictor for mortality in patients with chronic kidney disease and undergoing haemodialysis.
OBJECTIVE
The ankle brachial index (ABI) is a marker for peripheral artery disease and can predict mortality in advanced chronic kidney disease (CKD) and haemodialysis patients, respectively. However, it is seldom studied in Taiwan, an area with high prevalence of CKD and end-stage renal disease. The aim of this study was to investigate the predictors for mortality by using ABI value in patients with CKD and undergoing haemodialysis in Taiwan.


METHODS
One hundred and sixty-nine patients with CKD stage 3-5 and 231 haemodialysis patients were enrolled in one regional hospital. The mean follow-up period was 23.3 + or - 3.3 months. Patients were stratified into three groups according to ABI value (<0.9, > or = 0.9 to < 1.3, and > or = 1.3). The relative mortality risk was analyzed by Cox-regression methods.


RESULTS
In multivariate analysis, an ABI of 1.3 or more (hazard ratio, 3.846; P = 0.043) and coronary artery disease (P = 0.012) were positively associated with overall mortality, and serum low-density lipoprotein cholesterol level (P = 0.042) was negatively associated with overall mortality. In addition, an ABI of less than 0.9 (P = 0.049), an ABI of 1.3 or more (P = 0.033), coronary artery disease (P = 0.024) and haemodialysis treatment (P = 0.043) were strong predictors for cardiovascular mortality.


CONCLUSIONS
Our findings show that an ABI of 1.3 or more predicts for both overall and cardiovascular mortality, and an ABI of less than 0.9 predicts for cardiovascular mortality in CKD and haemodialysis patients. Screening patients with chronic renal failure by means of ABI may help to identify a high-risk group for increased mortality.
Chen
Szu-Chia
SC
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Chang
Jer-Ming
JM
Hwang
Shang-Jyh
SJ
Tsai
Jer-Chia
JC
Liu
Wan-Chun
WC
Wang
Chuan-Sheng
CS
Lin
Tsung-Hsien
TH
Su
Ho-Ming
HM
Chen
Hung-Chun
HC
D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006761:Hospitals; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome