Association of diabetes and hemodialysis with ankle pressure and ankle-brachial index in Japanese patients with critical limb ischemia.
OBJECTIVE
To investigate whether diabetes and regular hemodialysis are associated with false elevation of ankle systolic blood pressure and ankle-brachial systolic pressure index (ABI) because of their arterial calcification in patients with critical limb ischemia (CLI).


METHODS
We recruited 269 Japanese patients who underwent endovascular therapy for CLI. Ankle systolic blood pressure and ABI were assessed before endovascular therapy. Arterial stenosis and calcification were evaluated angiographically. We investigated the associations among clinical comorbidities, arterial calcification, and measurements of ankle systolic blood pressure and ABI.


RESULTS
Ankle systolic blood pressure was 85 ± 56 mmHg, and ABI was 0.59 ± 0.37. Arterial calcification was observed in 69% of the patients. The prevalence of diabetes and regular hemodialysis was 71 and 47%. Diabetes and regular hemodialysis were both significantly associated with the presence of arterial calcification; their adjusted odds ratios were 2.33 (P = 0.01) and 7.40 (P < 0.01), respectively. However, there was no significant difference in ankle systolic blood pressure or ABI level between those with and without these comorbidities. Furthermore, the presence of arterial calcification was not associated with ankle systolic blood pressure or ABI level, whereas arterial stenoses of all segments in the lower body had independent associations with reduced ankle systolic blood pressure and ABI level.


CONCLUSIONS
Diabetes and regular hemodialysis were significantly associated with arterial calcification, but not with elevated measurements of ankle systolic blood pressure or ABI, in CLI patients.
Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Mitsuyoshi
M
Takahara
Hideaki
H
Kaneto
Osamu
O
Iida
Naoto
N
Katakami
Taka-Aki
TA
Matsuoka
Masahiko
M
Ikeda
Iichiro
I
Shimomura
D000368:Aged; D000842:Ankle / Q000098:blood supply; D055109:Ankle Brachial Index; D044466:Asian People; D001794:Blood Pressure; D001916:Brachial Artery / Q000502:physiology; D002114:Calcinosis / Q000209:etiology; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000503:physiopathology*; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis; D006435:Renal Dialysis / Q000009:adverse effects