title: Ankle-brachial index: a simple way to predict mortality among patients on hemodialysis--a prospective study.
abstract: BACKGROUND
  Ankle-brachial index (ABI) can access peripheral artery disease and predict mortality in prevalent patients on hemodialysis. However, ABI has not yet been tested in incident patients, who present significant mortality. Typically, ABI is measured by Doppler, which is not always available, limiting its use in most patients. We therefore hypothesized that ABI, evaluated by a simplified method, can predict mortality in an incident hemodialysis population.
  
  
  RESULTS
  We studied 119 patients with ESRD who had started hemodialysis three times weekly. ABI was calculated by using two oscillometric blood pressure devices simultaneously. Patients were followed until death or the end of the study. ABI was categorized in two groups normal (0.9-1.3) or abnormal (<0.9 and >1.3). There were 33 deaths during a median follow-up of 12 months (from 3 to 24 months). Age (1 year) (hazard of ratio, 1.026; p = 0.014) and ABI abnormal (hazard ratio, 3.664; p = 0.001) were independently related to mortality in a multiple regression analysis.
  
  
  CONCLUSIONS
  An easy and inexpensive technique to measure ABI was tested and showed to be significant in predicting mortality. Both low and high ABI were associated to mortality in incident patients on hemodialysis. This technique allows nephrologists to identify high-risk patients and gives the opportunity of early intervention that could alter the natural progression of this population.
authors.affiliation: Renal Division, Internal Medicine, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Zaida Noemy Cabrera
authors.initials: ZN
authors.lastname: Jimenez
authors.forename: Benedito Jorge
authors.initials: BJ
authors.lastname: Pereira
authors.forename: João Egidio
authors.initials: JE
authors.lastname: Romão
authors.forename: Sonia Cristina da Silva
authors.initials: SC
authors.lastname: Makida
authors.forename: Hugo
authors.initials: H
authors.lastname: Abensur
authors.forename: Rosa Maria Affonso
authors.initials: RM
authors.lastname: Moyses
authors.forename: Rosilene Motta
authors.initials: RM
authors.lastname: Elias
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D001794:Blood Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D006435:Renal Dialysis