BackgroundAbnormal ankle-brachial index (ABI) has been found to be a strong predictor of mortality in some hemodialysis populations in studies with relatively short periods of follow-up, lower than 2 years.ObjectiveThis study aimed to assess the predictive value of abnormal ABI as a risk factor for death among patients on maintenance hemodialysis after a 5-year follow-up.MethodsA total of 478 patients on hemodialysis for at least 12 months were included in the study. ABI measurement was performed using a mercury column sphygmomanometer and portable Doppler. Patients were divided into 3 groups according to ABI (low: <0.9; normal: 0.9 to 1.3; and high: >1.3) and followed for a 60-month period.ResultsThe prevalence rates of low, normal and high ABI were 26.8%, 64.6% and 8.6%, respectively. The 5-year survival rate was lower in the groups with low ABI (44.1%, P<0.0001) and high ABI (60.8%, P= 0.025) than in the group with normal ABI (71.7%). Cox regression was used to evaluate the association between ABI and mortality, adjusting for potential confounders. Using normal ABI as reference, a low, but not a high ABI was found to be an independent risk factor for all-cause mortality (HR2.57; 95% CI, 1.84-3.57 and HR 1.62; 95% CI, 0.93-2.83, respectively).Conclusionslong-term survival rates of patients with either low or high ABI were lower than the one from those with normal ABI. However, after adjustment for potential confounders, only low ABI persisted as an independent risk factor for all-cause mortality among hemodialysis patients.

Background: Reduced ankle-arm index (AAI), inflammation and mineral bone disorder (MBD) are all associated with increased risk of death and cardiovascular complications in patients on hemodialysis (HD), but the association between them deserves clarification.

Background: Patients on hemodialysis present an increased risk of cardiovascular death. Intimal media thickness (IMT) and presence of arterial calcifications are well-known risk factors for cardiovascular death in hemodialysis patients.

Henoch-Schönlein purpura is a vasculitis of small vessels, characterized by tissue deposition of IgA, affecting predominantly the skin, intestine, joints and kidneys. It mainly affects the pediatric age group, especially from 2 to 11 years old. Most often, it is preceded by episode of upper airway infection from days to weeks. The most common clinical manifestations are purpuric cutaneous lesions located in the lower limbs and buttocks, abdominal pain in colic, nausea, vomiting, diarrhea, in addition to arthralgia/arthritis, usually with spontaneous resolution. Renal impairment usually manifests with hematuria and proteinuria, and renal function may also be impaired. The case described refers to a female patient, 86 years old, with a previous history of infection of the upper airways, followed by purpura in the lower limbs and renal impairment: serum creatinine 3.1 mg/dL (N 0.5 -1.2 mg/dL); glomerular filtration rate 15 ml/min (N > 60 ml/min); urea 118 mg/dL (N < 40 g/dL); proteinuria 4.497 mg/24h. The present report aims to draw attention to the occurrence of Henoch-Schönlein purpura in an atypical age group, with significant renal impairment, improvement only with conservative treatment, thus avoiding the use of immunosuppressants and the risks of immunosuppression and toxicity related to such drugs.