Abstract 14238: Ankle Brachial Pressure Index and C-Reactive Protein with Cardiovascular and All-cause Mortality in Hemodialysis Patients
Background: Ankle Brachial Pressure Index (ABPI) has been established as an indicator of not only peripheral artery disease but also systemic atherosclerosis. C-reactive protein (CRP) has been reported to reflect vascular wall inflammation and can predict future cardiovascular (CV) events. We investigated the association of ABPI, CRP and their joint role with prediction of CV and all-cause mortality in patients on hemodialysis (HD).
Methods: ABPI and serum CRP levels were measured in 442 HD patients. The patients were divided into tertiles according to ABPI levels; tertile 1 (T1): <1.02, T2: 1.02-1.20 and T3: > 1.20, and also to serum CRP levels; T1: <0.9 mg/l, T2: 0.9-3.7mg/l and T3: >3.7mg/l, respectively. All patients were followed up to 8 years.
Results: Serum CRP levels was 7.7±12.9mg/l, 4.5±0.74mg/l and 3.6±5.5mg/l in T1, T2 and T3 of ABPI, respectively (p=0.0006), and was independently associated with T1 of ABPI (odds ratio 1.40, 95%CI 1.07-1.83, p=0.013). Mean follow-up period was 71±27months. Adjusted hazard ratio (HR) of lower ABPI was 3.69 (95%CI 1.85-7.35, p=0.0006 for T1 vs. T3) for CV mortality and 2.23 (95%CI 1.38-3.61, p=0.0016 for T1 vs. T3) for all-cause mortality, respectively. Similarly, adjusted HR of elevated CRP levels was 2.58 (95%CI 1.33-5.01, p=0.019 for T3 vs. T1) for CV mortality and 2.52 (95%CI 1.56-4.09, p=0.0002 for T3 vs. T1) for all-cause mortality, respectively. In the joint setting of ABPI and CRP, the risk of CV and all-cause mortality was 15.1-fold (p=0.0024) and 11.2-fold (p=0.0009) in the T1 of ABPI with T3 of CRP compared to the T3 of ABPI with T1 of CRP even after adjustment, respectively (Figure).
Conclusions: Lower ABPI and elevated CRP levels might be closely associated, and the combination of these variables is more markedly related to increased mortality than either variable alone in HD patients. The measurement of ABPI and serum CRP is useful for the stratification of CV and all-cause mortality risk in this population.
- © 2010 by American Heart Association, Inc.