Ankle-brachial index as a predictor for mortality in patients with chronic kidney disease and hemodialysis

Authors

  • Szu-Chia Chen MD,

    1. Division of Nephrology,
    2. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University;
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  • Jer-Ming Chang MD, PhD,

    1. Division of Nephrology,
    2. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University;
    3. Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Shang-Jyh Hwang MD,

    1. Division of Nephrology,
    2. Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Jer-Chia Tsai MD,

    1. Division of Nephrology,
    2. Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Wan-Chun Liu MD,

    1. Division of Nephrology,
    2. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University;
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  • Chuan-Sheng Wang MD,

    1. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University;
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  • Tsung-Hsien Lin MD, PhD,

    1. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
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  • Ho-Ming Su MD,

    1. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
    2. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University;
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  • Hung-Chun Chen MD, PhD

    1. Division of Nephrology,
    2. Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • This is an Accepted Article that has been peer-reviewed and approved for publication in the Nephrology, but has yet to undergo copy-editing and proof correction. Please cite this article as an “Accepted Article”; doi: 10.1111/j.1440-1797.2009.01187.x

Ho-Ming Su. M.D.
Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University
482, Shan-Ming Rd., Hsiao-Kang Dist., 812 Kaohsiung, Taiwan, Republic of China
TEL: 886-7-8036783-3441, FAX: 886-7-8063346
E-mail: cobeshm@seed.net.tw

Abstract

Background. Ankle-brachial index (ABI) is a marker for peripheral artery disease and can predict mortality in advanced chronic kidney disease (CKD) and hemodialysis patients, respectively. However, it is seldom studied in Taiwan, an area with high prevalence of CKD and end-stage renal disease. The aim of this study was to investigate the predictors for mortality via using ABI value in patients with CKD and hemodialysis in Taiwan.

Methods. We enrolled 169 patients with CKD stage 3–5 and 231 hemodialysis patients in one regional hospital. The mean follow-up period was 23.3 ± 3.3 months. Patients were stratified into three groups according to ABI value (< 0.9, ≥ 0.9 to < 1.3, and ≥ 1.3). The relative mortality risk was analyzed by Cox-regression methods.

Results. In multivariate analysis, ABI ≥ 1.3 (hazard ratio, 3.846; P= 0.043), and coronary artery disease (P= 0.012) were positively associated with overall mortality, and serum low-density lipoprotein cholesterol level (P= 0.042) was negatively associated with overall mortality. In addition, ABI < 0.9 (P= 0.049), ABI ≥ 1.3 (P= 0.033), coronary artery disease (P= 0.024) and hemodialysis treatment (P= 0.043) were strong predictors for cardiovascular mortality.

Conclusions. Our findings show that ABI ≥ 1.3 predicts for both overall and cardiovascular mortality, and ABI < 0.9 predicts for cardiovascular mortality in CKD and hemodialysis patients. Screening patients with chronic renal failure by means of ABI may help to identify a high risk group for increased mortality.

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