title: Ankle Brachial Index and Subsequent Cardiovascular Disease Risk in Patients With Chronic Kidney Disease.
abstract: The clinical implications of ankle-brachial index (ABI) cutpoints are not well defined in patients with chronic kidney disease (CKD) despite increased prevalence of high ABI attributed to arterial stiffness. We examined the relationship of ABI with cardiovascular disease (CVD) and all-cause mortality among CKD patients.
  
  
  
  Three thousand six hundred twenty-seven participants without clinical peripheral artery disease (PAD) at baseline from the Chronic Renal Insufficiency Cohort Study were included. ABI was obtained per standard protocol and CVD events were confirmed by medical record adjudication. A U-shaped association of ABI with PAD, myocardial infarction (MI), composite CVD, and all-cause mortality was observed. Individuals with an ABI between 1.0 and <1.4 had the lowest risk of outcomes. Compared to participants with an ABI between 1.0 and <1.4, multiple-adjusted hazard ratios (95% confidence intervals) for those with an ABI of <0.9, 0.9 to <1.0, and ≥1.4 were 5.78 (3.57, 9.35), 2.76 (1.56, 4.88), and 4.85 (2.05, 11.50) for PAD; 1.67 (1.23, 2.29), 1.85 (1.33, 2.57), and 2.08 (1.10, 3.93) for MI; 1.51 (1.27, 1.79), 1.39 (1.15, 1.68), and 1.23 (0.82, 1.84) for composite CVD; and 1.55 (1.28, 1.89), 1.36 (1.10, 1.69), and 1.00 (0.62, 1.62) for all-cause mortality, respectively.
  
  
  
  This study indicates that ABI <1.0 was related to risk of PAD, MI, composite CVD, and all-cause mortality whereas ABI ≥1.4 was related to clinical PAD. These findings suggest that ABI cutpoints of <1.0 or ≥1.4 for diagnosing PAD and ABI <1.0 for CVD risk stratification should be further evaluated among CKD patients.
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA jchen@tulane.edu.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Emile R
authors.initials: ER
authors.lastname: Mohler
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, MA.
authors.forename: Pranav S
authors.initials: PS
authors.lastname: Garimella
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
authors.forename: L Lee
authors.initials: LL
authors.lastname: Hamm
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kimmel
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.affiliation: Los Angeles BioMed at Harbor-UCLA Medical Center, Los Angeles, CA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Pan
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Nessel
authors.affiliation: Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, MI.
authors.forename: Susan
authors.initials: S
authors.lastname: Steigerwalt
authors.affiliation: University Hospitals of Case Western Reserve University, Cleveland, OH.
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
authors.forename: Jiang
authors.initials: J
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D058729:Peripheral Arterial Disease / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D055815:Young Adult
keywords: ankle brachial index; cardiovascular disease; chronic kidney disease; heart failure; mortality; myocardial infarction; peripheral arterial disease