A Small Reduction in the Ankle-Brachial Index Is Associated with Increased Mortality in Patients on Chronic Hemodialysis

Abstract

Background: High pulse wave velocity (PWV) and a low ankle-brachial index (ABI) are associated with mortality in hemodialysis (HD) patients. Recently, the cardio-ankle vascular index (CAVI) was developed as a novel index of arterial stiffness independent of blood pressure. Methods: We compared brachial-ankle PWV (baPWV), the ABI and the CAVI as predictors of mortality in 194 HD patients (age 64 ± 12 years; time on HD 111 ± 96 months) during a follow-up period of 39 ± 4 months (range 31–46). Results: The ABI was significantly positively correlated with serum albumin and negatively with log-transformed highly sensitive C-reactive protein (p < 0.01), while baPWV and the CAVI were not. Of 194 patients, 39 patients (20.1%) died during the follow-up, 25 (64.1%) of cardiovascular causes. Kaplan-Meier analysis revealed that the patients with an ABI in the lowest tertile (<1.0) had a significantly lower survival rate (p < 0.01). Cox hazards analysis after adjustment for the conventional risk factors revealed that an ABI value in the lowest tertile was a determinant of total mortality when compared with ABI values in the highest tertile [>1.1; hazard ratio 3.50 (95% confidence interval 1.20–10.20); p = 0.02]. In contrast, baPWV and the CAVI were not associated with mortality. Conclusion: These findings suggest that a small reduction in the ABI (<1.0) is an independent predictor of all-cause mortality in chronic HD patients.

Cardio-Ankle Vascular Index (CAVI) as a Novel Indicator of Arterial Stiffness: Theory, Evidence and Perspectives

“…Izuhara et al 25) reported that CAVI is indepen- , Izuhara 25) , Miyoshi 26) , Horinaka 27) [Sairaku 29) ] Intima media thickness of cervical artery Nakamura 24) , Ibata 22) , Takaki 20,28) , Izuhara 25) , Miyoshi 26) , Okura 36) , Sairaku 29) , Horinaka 27) , Hayashi 38) Chronic kidney disease [Mortality rate in patients with hemodialysis] Izuhara 25) , Kobuzono 30) , Takenaka 31) , Nakamura 32) , Ueyama 33) , Satoh-Asahara 36) [Kato 40) ] Cerebral infarction, Dementia Yamamoto 39) Metabolic syndrome Satoh 55) Diabetes mellitus Ibata 22) , Izuhara 25) , Okura 37) Hypertension Kubozono 21) , Okura 37) , Takaki 42) , Kadota 43) Dyslipidemia Takaki 28) Smoking Kubozono 21) , Noike 62) Obstructive sleep apnea syndrome Kumagai 60) dently associated with the severity of coronary atherosclerosis. Recently, Miyoshi et al 26) also supported a correlation between CAVI and coronary atherosclerosis.…”

“…Kato et al 40) conducted a 39-month follow-up study on the mortality rate of 194 hemodialysis patients. They found that a small reduction in the ankle-brachial index is associated with increased mortality in patients on chronic hemodialysis, while CAVI and baPWV are not associated with mortality.…”

Brachial-Ankle PWV: Current Status and Future Directions as a Useful Marker in the Management of Cardiovascular Disease and/or Cardiovascular Risk Factors

“…Thirty articles examining the prognostic value of brachial-ankle PWV in prospective studies were identified 63, (Table 3). Of these, four studies examined the prognosis twice in the same cohorts [95][96][97][98] , and only one aggregate data meta-analysis is available to examine the usefulness of brachial-ankle PWV as a predictor of future cardiovascular events 99) . Age is an important determinant of arterial stiffness; therefore, PWV may be considered as a marker of aging, serving as an overall marker of death.…”

Risk Factors of Arterial Damage Assessed by ABI and baPWV among Hemodialysis Patients in Macau

“…A reduced ABI relates to further development of angina, myocardial infarction, stroke, and need for coronary bypass surgery. And it is a powerful independent predictor of all-cause and cardiovascular mortality in hemodialysis (HD) patients [5,6]. Pulse wave velocity (PWV), which provides a comprehensive assessment of arterial stiffness, is also a powerful and independent predictor of all-cause and cardiovascular mortality in ESRD patients [7,8].…”