Ankle-brachial blood pressure index predicts cardiovascular events and mortality in Japanese patients with chronic kidney disease not on dialysis

Abstract

The ankle-brachial blood pressure index (ABPI) has been recognized to have a predictive value for cardiovascular (CV) events and mortality in general or dialysis populations. However, the associations between ABPI and those outcomes have not been fully investigated in predialysis patients. The present study aimed to clarify the relationships between ABPI and both CV events and mortality in Japanese chronic kidney disease (CKD) patients not on dialysis. In this prospective observational study, we enrolled 320 patients with CKD stages 3-5 who were not on dialysis. At baseline, ABPI was examined and a low ABPI was defined as <0.9. CV events and all-cause deaths were examined in each patient. A Cox proportional hazards model was applied to determine the risk factors for CV events, as well as for mortality from CV and all causes. The median follow-up period was 30 months. CV events occurred in 56 patients and all-cause deaths occurred in 48, including 20 CV deaths. Multivariate analysis showed that age and low ABPI were risk factors for CV events. It was demonstrated that age, a history of cerebrovascular disease and low ABPI were determined as independent risk factors for CV mortality. In addition, age, body mass index and low ABPI were independently associated with all-cause mortality. In patients with CKD, low ABPI during the predialysis period is independently associated with poor survival and CV events, suggesting the usefulness of measuring ABPI for predicting CV events and patient survival in CKD.

Hyperuricemia Is Associated with Left Ventricular Dysfunction and Inappropriate Left Ventricular Mass in Chronic Kidney Disease

“…Atherosclerosis and vascular stiffness are common mechanisms in the pathogenesis of CV diseases, and can be assessed using the ABI and baPWV. In pre-dialysis patients with CKD stages 3–5, Yoshitomi et al reported that ABI can predict CV events, mortality and all-cause mortality [ 46 ]. Atherosclerosis and vascular stiffness may play roles in the link between serum UA and CV abnormalities.…”

Relationship between sex and cardiovascular mortality in chronic kidney disease: A systematic review and meta-analysis

“…The majority of the studies reported results for end-stage renal disease (ESRD) patients on dialysis: 30 studies included subjects exclusively on HD [15,16,19,20,, eight studies included subjects on PD [48][49][50][51][52][53][54][55], three studies included both HD and PD [17,18,56], and six studies reported their subjects were not on dialysis [21,[57][58][59][60][61]. Six studies defined their subjects as having CKD stages 3 to 5, [18,21,58,59,61,62], while only one study described their subjects as CKD stages 3 and 4 [60]. In addition to this, most studies (33/48) reported comorbidity with diabetes mellitus and hypertension.…”

The Addition of Vascular Calcification Scores to Traditional Risk Factors Improves Cardiovascular Risk Assessment in Patients with Chronic Kidney Disease

“…Aortic stiffness (as evaluated from the carotid femoral pulse wave velocity, PWV) has also emerged as a strong predictor of all-cause and CV mortality in CKD patients [ 12 , 13 ]. Chronic kidney disease patients with either an abnormally high ankle brachial index (ABI) or an ABI below 0.9 had a poor prognosis for all-cause and CV mortality [ 14 , 15 ]. The prevalence of vascular calcification increases steadily with the CKD stage and peaks in stage 5D patients [ 16 ].…”