title: Association of peripheral artery disease and long-term mortality in hemodialysis patients.
abstract: BACKGROUND
  Peripheral artery disease (PAD) is a common complication in hemodialysis patients. The ankle-brachial blood pressure index (ABI) has been widely used to screen for subclinical PAD. In the present study, we investigated the association between ABI and long-term (up to 8.8 years) mortality among hemodialysis patients.
  
  
  METHODS
  A total of 86 consecutive patients receiving maintenance hemodialysis who underwent an ABI examination between 2001 and 2003 were retrospectively enrolled in this study. Patients with an ABI of less than 0.9 were considered as having PAD; those with an ABI of more than 0.9 in both legs were considered as being free from PAD. We examined the relationship between mortality and several risk factors.
  
  
  RESULTS
  During the follow-up period, 43 deaths were recorded. In the univariate regression analysis, the mortality hazard ratio (HR) of patients with PAD was 1.67 (95% confidence interval [CI], 1.18-2.28). Other predictive variables for mortality included male gender, age, and diabetes mellitus (P = 0.006, P = 0.024, and P = 0.023, respectively). A multivariate Cox analysis identified PAD and male gender as independent predictors of mortality (P = 0.033 and P = 0.028, respectively). The impact of age and diabetes mellitus on mortality was no longer significant in the multivariate analysis.
  
  
  CONCLUSIONS
  After a relatively long-term observation period, a multivariate analysis indicated that PAD acted independently of other risk factors, including advanced age and the presence of diabetes mellitus. ABI measurements can be used to identify high-risk hemodialysis patients requiring intensive follow-up care.
authors.affiliation: Sangenjaya Hospital, 1-21-5 Sangenjaya, Setagaya-ku, Tokyo 154-0024, Japan. sotsubo@kc.twmu.ac.jp
authors.forename: Shigeru
authors.initials: S
authors.lastname: Otsubo
authors.forename: Mariko
authors.initials: M
authors.lastname: Kitamura
authors.forename: Takako
authors.initials: T
authors.lastname: Wakaume
authors.forename: Aiji
authors.initials: A
authors.lastname: Yajima
authors.forename: Miwa
authors.initials: M
authors.lastname: Ishihara
authors.forename: Masayo
authors.initials: M
authors.lastname: Takasaki
authors.forename: Syuitsu
authors.initials: S
authors.lastname: Ueda
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Kimiko
authors.initials: K
authors.lastname: Otsubo
authors.forename: Naoki
authors.initials: N
authors.lastname: Kimata
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors