Abstract 13647: Combined Prognostic Utility of Ankle Brachial Pressure Index and Protein-Energy Wasting for Predicting Clinical Outcome in Patients on Hemodialysis
Background: Ankle brachial pressure index (ABI) is a useful inspection to diagnose peripheral artery disease. On the other hand, protein-energy wasting (PEW), currently is considered to be due to inflammatory process rather than poor nutritional intake, is highly prevalent in patients on hemodialysis. We examined combined prognostic utility of ABI and PEW for predicting clinical outcome in HD patients.
Methods: We enrolled 1036 HD patients. They were divided into three groups according to ABI levels; normal group: 0.9-1.4 (n=682), high group: >1.4 (n=150) and low group: <0.9 (n=204), and were followed up for up to 8 years. They were also divided into tertiles according to geriatric nutritional risk index (GNRI) levels as a simplified marker of PEW state; tertile 1 (T1): <90.8, T2: 90.8-97.3 and T3: >97.3. GNRI was calculated as follows; GNRI = (14.89 х albumin) + [41.7 х (body weight / body weight at BMI of 22)].
Results: Subjects in T1 of GNRI levels frequently had abnormal ABI (<0.9 or >1.4) (odds ratio 0.97, 95%CI 0.96-0.99, p=0.0009). Kaplan-Meier analysis revealed that 8-year event-free survival rates from mortality were 62.8%, 46.2% and 27.3% among normal, high and low ABI groups, respectively (p<0.0001), and were 34.3%, 59.7% and 68.0% among T1, T2 and T3 of GNRI, respectively (p<0.0001). In the combined setting of ABI and GNRI, the risk of mortality was 4.26-fold (95%CI 2.63-6.90) higher in the low ABI group with T1 of GNRI and 3.69-fold (95%CI 2.30-5.91) higher in the high ABI group with T1 of GNRI compared to the normal ABI group with T3 of GNRI, respectively (Figure). Similar results were also obtained from cardiovascular mortality.
Conclusion: Abnormal ABI and lower GNRI levels could strongly predict worse clinical outcome in HD patients.
- © 2013 by American Heart Association, Inc.