title: Interankle systolic blood pressure difference and renal outcomes in patients with chronic kidney disease.
abstract: OBJECTIVE
  Interankle blood pressure (BP) difference has been associated with peripheral artery disease and adverse cardiovascular outcomes. However, the relationship between interankle BP difference and renal outcomes in chronic kidney disease (CKD) has never been evaluated. The purpose of this study was to determine whether interankle BP difference is associated with the rate of renal function decline and progression to renal end points in patients with stage 3-5 CKD.
  
  
  METHODS
  We enrolled 144 patients with CKD from one regional hospital. The BP in four limbs was simultaneously measured using an ABI-form device. The decline in renal function was evaluated using an estimated glomerular filtration rate (eGFR) slope. Rapid renal progression was defined as an eGFR slope < -3 mL/min per 1.73 m(2) per year. The renal end points were defined as ≥ 25% decline in eGFR or commencement of dialysis during the follow-up period.
  
  
  RESULTS
  During a mean follow-up period of 3.1 years, 90 patients (62.5%) reached renal end points. Multivariate analysis showed that an increased interankle systolic BP difference (per 5 mmHg) was associated with a worse eGFR slope (regression β, -0.292; 95% confidence interval [CI], -0.482 to -0.102; P = 0.003), rapid renal progression (odds ratio, 1.189; 95% CI, 1.015-1.394; P = 0.032), and an increased risk of progression to renal end points (hazard ratio, 1.126; 95% CI, 1.052-1.204, P = 0.001).
  
  
  CONCLUSIONS
  Interankle systolic BP difference was associated with rapid renal progression and progression to renal end points in patients with stage 3-5 CKD in our study.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.|Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University.|Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University.|Faculty of Medicine.
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.|Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University.|Faculty of Medicine.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Tsai
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.|Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University.
authors.forename: Jiun-Chi
authors.initials: JC
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.
authors.forename: Su-Chu
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.|Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University.|Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Jer-Ming
authors.initials: JM
authors.lastname: Chang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.|Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.|Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply*; D055109:Ankle Brachial Index; D001794:Blood Pressure; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors
keywords: chronic kidney disease; interankle blood pressure difference; renal function progression