Ankle—brachial index, vascular calcifications and mortality in dialysis patients

• Published in: Nephrology, dialysis, transplantation Vol. 27; no. 1; pp. 318 - 325
• Main Authors: ADRAGAO, Teresa, PIRES, Ana, BRANCO, Patricia, CASTRO, Rui, OLIVEIRA, Ana, NOGUEIRA, Cristina, BORDALO, Joaquim, CURTO, José Dias, PRATA, Mateus Martins
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 2012
• Subjects: Age; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Ankle - blood supply; Ankle - pathology; Ankle Brachial Index; Aorta; Arteries; Biological and medical sciences; Blood Pressure; Brachial Artery - physiopathology; Calcification; Calcification (ectopic); Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cross-Sectional Studies; Diabetes mellitus; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Glomerular Filtration Rate; Glomerulonephritis; Hand; Hemodialysis; Humans; Intensive care medicine; Ionizing radiation; Male; Medical sciences; Mortality; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Pelvis; Prognosis; Prospective Studies; Renal Dialysis - adverse effects; Renal Dialysis - mortality; Risk Factors; Survival Rate; Vascular Calcification - etiology; Vascular Calcification - mortality; Kidney disease; Human; Extrarenal dialysis; Urinary system disease; Hemodialysis; Mortality; Renal failure; CKD 5D; Calcification; Dialysis; vascular calcifications; ankle-brachial index
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfr233

The ankle-brachial index (ABI) is a noninvasive method to evaluate peripheral artery disease (PAD). ABI <0.9 diagnoses PAD; ABI >1.3 is a false negative caused by noncompressible arteries. The aim of this study is to evaluate the association between ABI with vascular calcifications (VC) and with mortality, in haemodialysis (HD) patients.
We studied 219 HD patients (60% male; 20% diabetic). At baseline, ABI was evaluated by a Doppler device. VCs were evaluated by two methods: the abdominal aorta calcification score (AACS) in a lateral plain X-ray of the abdominal aorta and the simple vascular calcification score (SVCS) in plain X-rays of the pelvis and hands. VC were also classified by their anatomical localization in main vessels (aorta and iliac-femoral axis) and in peripheral or distal vessels (pelvic, radial or digital). The cutoff values for the different VC scores in relation with ABI were determined by receiver operating characteristic curve analysis. Biochemical parameters were time averaged for the 6 months preceding ABI evaluation.
An ABI <0.9, an ABI >1.3 or a normal ABI were found, respectively, in 90 (41%), in 42 (19%) and in 87 (40%) patients. AACS ≥6 and SVCS >3 were found, respectively, in 98 (45%) and 95 (43%) patients. The adjusted odds ratio (OR) for having an ABI <0.9 was 2.5 (P = 0.007) for AACS ≥6 and 4.5 (P < 0.001) for iliac-femoral calcification score (CS) ≥2. The adjusted OR for having an ABI >1.3 was 4.2 (P = 0.003) for pelvic CS and 3.7 (P = 0.006) for hand CS ≥2. During an observational period of 28.9 months, all-cause and cardiovascular mortality occurred, respectively, in 50 (23%) and in 29 (13%) patients. Adjusting for age, diabetes, P levels, HD duration and cardiovascular disease at baseline, an ABI <0.9 [hazard ratio (HR) = 3.9, P < 0.001] and an ABI >1.3 (HR = 2.7, P = 0.038) were associated with all-cause mortality; an ABI <0.9 (HR = 7.2, P = 0.002) and an ABI >1.3 (HR = 5.1, P = 0.028) were associated with cardiovascular mortality.
Both low and high ABI were independent predictors of all-cause and cardiovascular mortality. VC in main arteries were associated with an ABI <0.9. VC in peripheral and distal arteries were associated with an ABI >1.3. ABI is a simple and noninvasive method that allows the identification of high cardiovascular risk patients.