Factors influencing pathological ankle-brachial index values along the chronic kidney disease spectrum: the NEFRONA study

Arroyo, David; Betriu, Àngels; Valls, Joan; Górriz, José Luis; Pallarés, Vicente; Abajo, Maria; Gracia, Marta; Valdivielso, José M.; Fernàndez, Elvira

doi:10.1093/ndt/gfw039

Cited by 31 publications

(36 citation statements)

References 49 publications

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“…Studies had shown that OPG levels could be modulated by inflammatory cytokines, and the presence and severity of PAD were correlated with inflammation [10,11,17,20]. In a multicenter prospective study, high-sensitivity CRP was significantly associated with abnormal ABI levels, revealing that inflammation played a role in the PAD pathogenesis [17]. Moreover, in patients on PD who had PAD, lower albumin and higher CRP levels were found respectively than those without PAD [20].…”

Section: Discussionmentioning

confidence: 97%

“…In the National Health and Nutrition Examination Survey, participants with estimated creatine clearance of <60 mL/min/1.72 m 2 had a 2.5-fold higher risk for developing PAD than those with >60 mL/min/1.72 m 2 , independent of traditional factors [16]. With the advancement of CKD, the PAD prevalence also increased as compared with the normal renal function [17]. Moreover, a nationwide cohort study conducted in Taiwan showed that the overall PAD incidences were 24.2, 12.4, and 20.7 per 1,000 person-years with respectively 4.4-fold, 2.78-fold, and 3.94-fold increased risks in the HD, PD, and all ESRD patients, which emphasized renal function as a risk factor for PAD [18].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Avila et al showed that OPG was associated with more severe arterial calcification in PD patients [13]. Studies had shown that OPG levels could be modulated by inflammatory cytokines, and the presence and severity of PAD were correlated with inflammation [10,11,17,20]. In a multicenter prospective study, high-sensitivity CRP was significantly associated with abnormal ABI levels, revealing that inflammation played a role in the PAD pathogenesis [17].…”

Section: Discussionmentioning

confidence: 99%

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Serum osteoprotegerin level is positively associated with peripheral artery disease in patients with peritoneal dialysis

et al. 2020

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Osteoprotegerin (OPG) is a potential biomarker of cardiovascular disease complications and severity. Peripheral arterial disease (PAD) is associated with an increased risk of death in patients on peritoneal dialysis (PD). Therefore, this study aimed to evaluate the relationship between serum OPG levels and PAD by measuring the ankle-brachial index (ABI) of patients on PD. A commercial enzyme-linked immunosorbent assay kit was used to measure OPG values. Left or right ABI values of <0.9 were categorized as the low ABI group. Among 70 patients on PD, 13 (18.6%) were categorized in the low ABI group. Patients in the low ABI group had higher prevalence of diabetes mellitus (p ¼ .044) and higher serum C-reactive protein (CRP) (p < .001) and OPG levels (p < .001) but lower creatinine (p ¼ .013) and peritoneal Kt/V (p ¼ .048) levels than those in the normal ABI group. Results of multivariable logistic regression analysis revealed that OPG [adjusted odds ratio (aOR) 1.027, 95% confidence interval (CI) 1.010-1.045, p ¼ .002] and CRP (aOR 1.102, 95% CI 1.006-1.207, p ¼ .037) levels were independent predictors of PAD in patients on PD. OPG can also be used to predict PAD development with the area under the receiver operating characteristic curve of 0.823 (95% CI: 0.714-0.904, p < .001) in patients on PD. Therefore, serum OPG and CRP levels can be considered as risk factors for PAD development in patients on PD.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Serum osteoprotegerin level is positively associated with peripheral artery disease in patients with peritoneal dialysis

et al. 2020

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“…The modified method was chosen for a higher sensitivity, selecting in each patient the most pathological of the four values. [ 24 ] A pathologic ABI was defined as a value ≤0.9 (diagnostic of limb ischemia) or ≥1.4 (related to arterial incompressibility and stiffness, usually ascribed to vascular ageing degeneration).…”

Section: Methodsmentioning

confidence: 99%

Factors predicting cardiovascular events in chronic kidney disease patients. Role of subclinical atheromatosis extent assessed by vascular ultrasound

et al. 2017

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Patients with chronic kidney disease (CKD) have an increased incidence of cardiovascular events (CVE). The contribution of subclinical atheromatosis extent, including femoral arteries, to CVE in CKD patients has not been investigated. In this paper, we examine the prognostic value of subclinical atheromatosis extent, assessed as the number of arterial territories with plaque, in predicting the incidence of major and minor CVE. The NEFRONA is a multicenter, prospective cohorts study that recruited 2445 CKD subjects and 559 controls, free from previous cardiovascular disease, in 81 medical centers across Spain. The presence of atheroma plaque was assessed by arterial ultrasound in ten arterial territories (carotid and femoral). The predictive power of the presence or absence of atheroma plaque in any territory was compared with the quantification of atheroma extent as the number of territories with plaque. During the median follow up of 48 months, 216 CVE were reported. Factors predicting the incidence of CVE in the whole cohort were being male, CKD patient, lower levels of 25(OH) vitamin D, higher levels of cholesterol and the extent of subclinical atheromatosis, yielding a higher concordance (C) index than the presence or absence of plaque. In stratified analysis including specific factors of CKD patients not on dialysis, the variables predicting CVE were the same as in the whole cohort, plus higher levels of potassium. Again, the inclusion of the information about atheromatosis as number of territories with plaque, presented a higher C index than the presence or absence of plaque. In the dialysis population, significant variables were older age, diabetes, dialysis vintage and higher levels of cholesterol and phosphate. In this case the higher C index was obtained with the information about plaque presence.Subclinical atheromatosis extent, including femoral arteries, influences CVE in CKD and its detection could improve the prediction of cardiovascular events.

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“…Current health status, medical history, baseline cardiovascular risk factors, and drug use information was obtained at baseline. A physical examination was performed, consisting of anthropometric measures, standard vital tests, and ABI measurements as previously described (24). A pathologic ABI was described as #0.9 or $1.4.…”

Section: Clinical Data and Laboratory Examinationsmentioning

confidence: 99%

Association of FGF-2 Concentrations with Atheroma Progression in Chronic Kidney Disease Patients

Božić

Betriu

Bermúdez-López

et al. 2018

CJASN

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Factors influencing pathological ankle-brachial index values along the chronic kidney disease spectrum: the NEFRONA study

Abstract: Asymptomatic PAD is very prevalent in all CKD stages, but factors related to a low or high pathological ABI differ, revealing different pathogenic pathways. Diabetes, dyslipidaemia, inflammation and mineral-bone disorders play a role in the appearance of PAD in CKD.

Cited by 31 publications

References 49 publications

Serum osteoprotegerin level is positively associated with peripheral artery disease in patients with peritoneal dialysis

Serum osteoprotegerin level is positively associated with peripheral artery disease in patients with peritoneal dialysis

Factors predicting cardiovascular events in chronic kidney disease patients. Role of subclinical atheromatosis extent assessed by vascular ultrasound

Association of FGF-2 Concentrations with Atheroma Progression in Chronic Kidney Disease Patients

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