title: Association of ankle-arm index with inflammation and mineral bone disorder in hemodialysis patients.
abstract: BACKGROUND
  Reduced ankle-arm index (AAI), inflammation and mineral bone disorder (MBD) are all associated with increased risk of death and cardiovascular complications in patients on hemodialysis (HD), but the association between them deserves clarification.
  
  
  OBJECTIVE
  To evaluate the association between abnormal AAI with MBD and inflammation in patients on HD.
  
  
  METHODS
  This was a cross-sectional analysis of 478 patients on hemodialysis for at least one year. The AAI was evaluated using a portable Doppler and mercury column manometer. Patients were divided into 3 groups, according to AAI (low: <0.9, normal: 0.9 to 1.3, and high: >1.3). C-reactive protein measurement was used as an inflammatory marker, whereas MBD was evaluated by calcium, phosphorus and intact parathyroid hormone levels.
  
  
  RESULTS
  Participants were 54 (18 to 75) years old, 56% males, 17% diabetics, and had been on hemodialysis for a mean of 5 (1 to 35) years. The prevalence of low, normal and high AAI was 26.8%, 64.6% and 8.6%, respectively. Using a backward conditional logistic regression model, age (p<0.001), diabetes (p= 0.001), and C-reactive protein levels >6 mg/L (p= 0.006) were associated with the presence of low AAI, whereas male gender (p<0.001), diabetes (p= 0.001) and elevated calcium x phosphorus product (p= 0.026) were associated with high AAI.
  
  
  CONCLUSIONS
  In patients on hemodialysis, the presence of diabetes was associated with both low and high AAI. The risk of having low AAI seems to be increased by aging and inflammation, whereas BMD was associated with high AAI.
authors: Divisão de Nefrologia, Departmento de Medicina, Universidade Federal Fluminense, Niteroi, RJ, Brasil.
authors: Jair B
authors: JB
authors: Miguel
authors: Jorge P
authors: JP
authors: Strogoff de Matos
authors: Frederico
authors: F
authors: Ruzany
authors: Claudia S
authors: CS
authors: Miguel
authors: Sebastião J S
authors: SJ
authors: Miguel
authors: Luiz T
authors: LT
authors: Naveiro
authors: Jocemir R
authors: JR
authors: Lugon
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood; D001851:Bone Diseases, Metabolic / Q000175:diagnosis*; D002318:Cardiovascular Diseases / Q000209:etiology*; D003920:Diabetes Mellitus / Q000209:etiology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers