title: Peripheral artery disease and blood pressure profile abnormalities in hemodialysis patients.
abstract: BACKGROUND
  Patients undergoing chronic hemodialysis (HD) are at increased risk for peripheral artery disease (PAD). Both ankle-brachial index (ABI) and ambulatory blood pressure monitoring (ABPM) in the interdialytic period have been shown to be strong predictors of all-cause mortality.
  
  
  METHODS
  This cross-sectional study investigated the relationship between ABPM profile and ABI in 81 HD patients. ABPM was measured throughout a 44-h midweek interdialytic period. Pre-dialysis ABI was evaluated with a BOSO ABI device. An ABI value <0.9 or ≥1.3 was defined as abnormal.
  
  
  RESULTS
  In the whole study group (72 % males, mean age 67 ± 14 years), there was an increase in BP (p < 0.05) and in systolic BP night/day ratio (n/dSR, p = 0.01) during the interdialytic period. Patients with abnormal ABI (n = 29) more frequently had a positive history for cerebrovascular accident and PAD and higher proBNP values than those with normal ABI (n = 52). No difference was detected among ABPM-derived components except for the n/dSR (p = 0.02). Patients with abnormal ABI showed a significantly increased n/dSR (p = 0.02) and ambulatory arterial stiffness index (AASI) (p = 0.006) on the second day compared to the first. Patients with n/dSR >1 during day 2 (n = 34) were older, showed significantly higher proBNP and AASI and were more likely to reveal abnormal ABI compared to those with a lower n/dSR (p = 0.006).
  
  
  CONCLUSIONS
  Abnormal ABI in HD patients is associated to changes in interdialytic ABPM pattern, namely higher n/dSR on day 2. These data may indicate the pathophysiological mechanisms underlying the worse outcome observed in HD patients.
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy. francesca.viazzi@unige.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Viazzi
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Leoncini
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Ratto
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Storace
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Gonnella
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Debora
authors.initials: D
authors.lastname: Garneri
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bonino
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cappadona
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Emanuele L
authors.initials: EL
authors.lastname: Parodi
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Verzola
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Garibotto
authors.affiliation: Department of Internal Medicine, University of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16132, Genoa, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pontremoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology*; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors; D059289:Vascular Stiffness
keywords: Ambulatory blood pressure monitoring; Hemodialysis; Hypertension; Peripheral artery disease; Stiffness