When is the best moment to assess the ankle brachial index: pre- or post-hemodialysis?
BACKGROUND
Cardiovascular disease is an important cause of death in patients on dialysis. Peripheral arterial disease (PAD) is a prognostic factor for cardiovascular disease. The ankle brachial index (ABI) is a noninvasive method used for the diagnosis of PAD. The difference between ABI pre- and post-dialysis had not yet been formally tested, and it was the main objective of this study.


METHODS
The ABI was assessed using an automated oscillometric device in incident patients on hemodialysis. All blood pressure readings were taken in triplicate pre- and post-dialysis in three consecutive dialysis sessions (times 1, 2, and 3).


RESULTS
One hundred and twenty-three patients (85 men) aged 53 ± 19 years were enrolled. We found no difference in ABI pre- and post-dialysis on the right or left side, and there was no difference in times 1, 2, and 3. In patients with a history of PAD, the ABI pre- versus post-dialysis were of borderline significance on the right side (p = 0.088).


CONCLUSIONS
ABI measured pre- and post-dialysis presented low variability. The ABI in patients with a history of PAD should be evaluated with caution. The applicability of the current method in predicting mortality among patients on hemodialysis therefore needs further investigation.
Renal Division, Internal Medicine, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
Zaida Noemy Cabrera
ZN
Jimenez
Isac
I
de Castro
Benedito Jorge
BJ
Pereira
Rodrigo Bueno
RB
de Oliveira
João Egidio
JE
Romão
Rosilene Motta
RM
Elias
D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index / Q000379:methods* / Q000592:standards; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D013997:Time Factors