Prognostic Significance of Abnormal Ankle–Brachial Index Among Long-term Hemodialysis Patients in Kinshasa, the Democratic Republic of the Congo

Abstract

Objective: Early identification of atherosclerosis using a non-invasive tool like ankle–brachial index (ABI) could help reduce the risk for cardiovascular disease among long-term hemodialysis patients. The study objective was to assess the frequency and impact of abnormal ABI as a marker of subclinical peripheral artery disease (PAD) in chronic hemodialysis patients. Methods: This was a historic cohort study of kidney failure patients on long-term hemodialysis for at least 6 months. The ABI, measured with two oscillometric blood pressure devices simultaneously, was used to assess subclinical atherosclerosis of low limb extremities. Abnormal ABI was defined as ABI <0.9 or >1.3 (PAD present). Survival was defined as time to death. Independent factors associated with abnormal ABI were assessed using multiple logistic regression analysis. Kaplan–Meier method (log-rank test) was used to compare cumulative survival between the two groups; a P value <0.05 was statistically significant. Results: Abnormal ABI was noted in 50.6% (n=43) of the 85 kidney failure patients included in the study; 42.4% (n=36) had a low ABI, and 8.2% (n=7) had a high ABI. Factors associated with PAD present were cholesterol (adjusted odds ratio [AOR], 1.02; 95% confidence interval [CI], 1.01–1.04; P=0.019), inflammation (AOR, 9.44; 95% CI, 2.30–18.77; P=0.002), phosphocalcic product (AOR, 6.25; 95% CI, 1.19–12.87; P=0.031), and cardiac arrhythmias (AOR, 3.78; 95% CI, 1.55–7.81, P=0.009). Cumulative survival was worse among patients with PAD present (log-rank; P=0.032). Conclusion: The presence of PAD was a common finding in the present study, and associated with both traditional and emerging cardiovascular risk factors as well as a worse survival rate than patients without PAD.

Oxidative Stress and Inflammation Markers Associated with Multiple Peripheral Artery Occlusions in Elderly Patients

“…In lower extremity arterial occlusions, atherosclerotic plaques encroach on the arterial lumen of the lower extremities. 64 Pro-inflammatory response also leads to oxidative stress and the transcription of pro-inflammatory genes is further increased by oxidative stress. 64 It is quite possible that the atherosclerosis plaques, intraplaque hemorrhages, and thin fibrous caps in lower leg vessels, due to the oxidative stress and expressions of MIME/NF-κB/P53/TLR4 inflammatory pathway, may favor development of multiple peripheral artery occlusions in older patients.…”

Circulating Proprotein Convertase Subtilisin/Kexin Type 9 Levels Predict Future Cardiovascular Event Risks in Hemodialyzed Black African Patients

“…4 Indeed, it has been reported in the literature that the high cardiovascular risk associated with CKD and kidney replacement therapy could be partially explained by the acceleration of the dynamic process of atherosclerosis induced by dyslipidemia. [5][6][7] In this regard, serum protein proprotein convertase subtilisin/ kexin type 9 (PCSK9) has been identified as the main factor inducing the increased synthesis of verylow-density lipoprotein cholesterol (triglyceride-rich lipoprotein), a factor underlying the development of atherogenic dyslipidemia and the subsequent elevated cardiovascular risk. 8 The plasma protein PCSK9 acts, in large part, by targeting and reducing the hepatic degradation of very-low-density lipoprotein, a lipoprotein containing apolipoprotein B (apo-B) and low-density lipoprotein cholesterol (LDLc).…”