title: Association of interleg BP difference with overall and cardiovascular mortality in hemodialysis.
abstract: OBJECTIVE
  An interarm BP difference has been associated with atherosclerosis and adverse cardiovascular outcomes. This study investigated whether an interleg BP difference was associated with peripheral vascular disease and overall and cardiovascular mortality in hemodialysis patients.
  
  
  METHODS
  This study enrolled 210 hemodialysis patients from December 2006 to January 2007. Bilateral leg BPs were measured simultaneously by an ankle-brachial index (ABI)-form device before hemodialysis.
  
  
  RESULTS
  The mean follow-up period was 4.4±1.5 years. ABI <0.9 and high brachial-ankle pulse wave velocity were independently associated with an interleg difference in systolic BP of ≥15 mmHg or diastolic BP of ≥10 mmHg. Furthermore, this difference was an independent predictor for overall mortality (hazard ratio [HR], 3.36; 95% confidence interval [CI], 1.68-6.72; P<0.01) and cardiovascular mortality (HR, 4.84; 95% CI, 1.84-12.71; P<0.01) after adjustment for demographic, clinical, and biochemical parameters. After further adjustment for ABI <0.9 and brachial-ankle pulse wave velocity, the relation remained significant to overall mortality (HR, 2.91; 95% CI, 1.28-6.64; P=0.01) and cardiovascular mortality (HR, 3.15; 95% CI, 1.05-9.44; P=0.04).
  
  
  CONCLUSIONS
  A difference in systolic BP of ≥15 mmHg or diastolic BP of ≥10 mmHg between legs was associated with peripheral vascular disease and increased risk for overall and cardiovascular mortality in hemodialysis patients. Detection of an interleg BP difference may identify hemodialysis patients at increased risk of peripheral vascular disease and overall and cardiovascular mortality.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Chen
authors.forename: Jer-Ming
authors.initials: JM
authors.lastname: Chang
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Tsai
authors.forename: Jer-Chia
authors.initials: JC
authors.lastname: Tsai
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D016009:Chi-Square Distribution; D015897:Comorbidity; D003971:Diastole; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D063177:Pulse Wave Analysis; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012307:Risk Factors; D013599:Systole; D013997:Time Factors