title: Detection of peripheral artery disease by duplex ultrasonography among hemodialysis patients.
abstract: OBJECTIVE
  Peripheral arterial disease (PAD) is a known predictor of cardiovascular morbidity and mortality among hemodialysis patients. Although ankle-brachial BP index (ABI) is a simple and reliable test for PAD screening, its sensitivity has been suggested to decrease among dialysis patients.
  
  
  METHODS
  We performed a cross-sectional outpatient cohort study to examine prevalence of PAD among hemodialysis patients using duplex ultrasonography of the lower extremity artery. We also evaluate the influence of increased arterial stiffness on impaired accuracy of ABI for PAD screening.
  
  
  RESULTS
  Of 315 total patients, 23.8% had PAD. PAD was associated with younger age, diabetes, current smoking, atherosclerotic comorbidities, increased total cholesterol levels, increased triglyceride levels, and lower Kt/V. The receiver operating characteristic analysis (area under the receiver operating characteristic curve = 0.846) showed that sensitivity and specificity of ABI values for PAD were 49.0 and 94.8%, respectively. An ABI cut-off value of 1.05 resulted in the best sensitivity (74.5%) and specificity (84.4%). There was a significant difference in sensitivity of ABI levels <0.9 for detecting PAD among patients in different brachial-ankle pulse wave velocity quartiles. In patients with the highest brachial-ankle pulse wave velocity quartile, PAD was most prevalent (46.5%), and ABI had the highest accuracy in detecting PAD (area under the curve, 0.933).
  
  
  CONCLUSIONS
  These results suggest that duplex ultrasonography was a useful tool for screening asymptomatic PAD among hemodialysis patients and that the diagnostic value of ABI for PAD was affected by various factors.
authors.affiliation: Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan. ogatah@med.showa-u.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ogata
authors.forename: Chiaki
authors.initials: C
authors.lastname: Kumata-Maeta
authors.forename: Kanji
authors.initials: K
authors.lastname: Shishido
authors.forename: Masahide
authors.initials: M
authors.lastname: Mizobuchi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Koiwa
authors.forename: Eriko
authors.initials: E
authors.lastname: Kinugasa
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001783:Blood Flow Velocity; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012372:ROC Curve; D006435:Renal Dialysis / Q000009:adverse effects*; D014463:Ultrasonography
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