Ankle-Brachial Index and Risk Factors for Peripheral Arterial Disease in Dialysis Patients

Jung, Ji Yoon; Ham, Young Rok; Jang, Won Ik; Chung, Sarah; Choi, Dae Eun; Na, Ki Ryang; Lee, Kang Wook; Shin, Young Tai

Abstract

PURPOSE
Peripheral arterial disease (PAD) is a predictable marker of coronary heart disease and cerebrovascular disease and its prevalence among chronic kidney disease (CKD) patients especially in end-stage renal disease (ESRD) patients undergoing dialysis is apparently increasing. Ankle-brachial index (ABI) is regarded as an easy, reliable, and noninvasive measure of the presence and severity of lower-extremity PAD (ABI<0.9). The aims of this study are to find out the prevalence of lower limb PAD measured by ABI, and to assess the risk factors of PAD in patients with ESRD.
METHODS
One hundred thirty eight ESRD patients from May 2005 to September 2009 who were performed ABI examination were categorized into PAD (ABI<0.9) or non-PAD (ABI> or =0.9) and the prevalence of PAD was analyzed. We measured ABI with VP2000 PWV/ankle-brachial index. We also reviewed the clinical characteristics and evaluated the risk factors of PAD, retrospectively.
RESULTS
One hundred seventeen patients on hemodialysis, and twenty one patients on peritoneal dialysis were included in this study. The mean age of total patients was 60.1 (24-84) years old. Thirty five patients out of one hundred thirty eight patients had an ABI index of less than 0.9 (PAD indicative). PAD was independently associated with age (p=0.013), duration of dialysis (p=0.013), history of coronary artery disease and cerebrovascular disease (p=0.001, p=0.001 respectively), diabetes (p=0.034), and increased LDL cholesterol (p=0.004) in univariate analysis. In multivariate logistic regression analysis, duration of dialysis, increased level of LDL-cholesterol and history of coronary artery disease were significantly related with PAD (p=0.008, p=0.019, p=0.018 respectively).
CONCLUSION
Duration of dialysis, increased level of LDL-cholesterol and coronary artery disease were independent risk factors for PAD in patients with ESRD on dialysis.