title: Ankle brachial index as a predictor for mortality in patients with chronic kidney disease and undergoing haemodialysis.
abstract: 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.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Chen
authors.forename: Jer-Ming
authors.initials: JM
authors.lastname: Chang
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Jer-Chia
authors.initials: JC
authors.lastname: Tsai
authors.forename: Wan-Chun
authors.initials: WC
authors.lastname: Liu
authors.forename: Chuan-Sheng
authors.initials: CS
authors.lastname: Wang
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Lin
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: 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