Is chronic kidney disease associated with a high ankle brachial index in adults at high cardiovascular risk?
OBJECTIVE
Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease (CVD) events. A high ankle brachial index (ABI), a marker of lower arterial stiffness, is associated with CVD events. It remains unknown whether high ABI is associated with CKD. The objectives of this study were to determine the association of CKD with high ABI in adults at high CVD risk.


METHODS
The study enrolled hospital-based patients at high CVD risk and measured kidney function and ABI. The glomerular filtration rate (GFR) was estimated using the Modification of Dietin Renal Desease (MDRD) equation and ABI was categorized as low (< 0.90), low-normal (0.90 to 1.09), normal (1.10 to 1.40), and high (≥ 1.40 or incompressible). Logistic regression was used to evaluate the associations of CKD with ABI categories.


RESULTS
Among 6412 participants, 25% had CKD, 25% had an ABI measurement < 0.90, and 1% had an ABI > 1.40. In models adjusted for age, sex, hypertension, diabetes, body mass index, low-density and high-density lipoprotein cholesterol, and smoking, only low ABI was associated with an increased risk of CKD; however, both low ABI (OR: 2.1, 1.6-2.8) and high ABI (OR: 2.4, 1.0-6.4) were associated with an increased risk of CKD in diabetic individuals. Additionally, only low ABI was associated with advanced eGFR levels.


CONCLUSIONS
High ABI values are associated with an increased risk of CKD in diabetic individuals at high cardiovascular risk. Future studies are required to speculate whether high ABI might lead to diminished kidney function through nonatherosclerotic pathways and to understand the mechanisms linking them to CVD events and diabetes.
Clinical Research Institute, Fudan University School of Public Health, Shanghai 200032, China.
Hao
H
Liu
Hong
H
Shi
Jinming
J
Yu
Fang
F
Chen
Qingwu
Q
Jiang
Dayi
D
Hu
D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D002318:Cardiovascular Diseases / Q000150:complications* / Q000628:therapy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate