Abstract 3445: Ankle Brachial Pressure Index is Individually Useful for Risk Stratification of Coronary, Cerebral and Peripheral Artery Related Events in Hemodialysis Patients
Background: Ankle brachial pressure index (ABPI) has been widely recognized as a marker of peripheral arterial disease (PAD), and PAD has been known to be “a window of systemic arteriosclerosis”. Thus, ABPI may have a possibility to predict not only PAD but also coronary heart disease (CHD) and stroke individually. We examined whether ABPI and pulse wave velocity (PWV) predict individual systemic arteriosclerosis related events in hemodialysis (HD) patients.
Methods: A total of 445 outpatients on HD (male 59%, age 63 ± 11years, diabetes 48%) undergoing both ABPI and PWV measurements were enrolled into this study. These patients were divided into 3 groups according to ABPI>0.9 (n=365), 0.7– 0.9 (n=49) and <0.7 (n=31). Also, they were divided into tertiles according to PWV level (T1; <1850m/sec, T2; 1850 –2310m/sec and T3; >2310m/sec). All patients were prospectively followed-up for 5 years.
Results: During 43 ± 17months, 98 CHD (22%), 31 stroke (7%), 33 PAD (8%) and totally 162 cardiovascular (CV) events occurred, and 78 patients (18%) died (42 CV death). Cox analysis showed that ABPI were the significant predictor of all individual events and mortality even after adjustment for male, age, duration of HD, traditional risk factors, previous CHD and stroke, hemoglobin, albumin, total cholesterol, LDL cholesterol and C-reactive protein (Table⇓). On the other hand, PWV was a predictor only for all-cause death on univariate analysis (HR 2.52, 95%CI 1.33– 4.79 for T3 vs. T1, p=0.01) but not significant on multivariate analysis. Event-free survival was 75%, 45% and 39% for CHD (p<0.0001), 91%, 81% and 73% for stroke (p=0.0007) and 95%, 56% and 55% for PAD (p<0.0001) among the groups with ABPI>0.9, 0.7– 0.9 and <0.7, respectively.
Conclusion: These data suggest that ABPI is useful for risk stratification of individual systemic arteriosclerosis related events in HD patients. Thus, ABPI would serve as a window of systemic arteriosclerosis.