Ankle-Brachial Index as a Predictor of Mortality in Hemodialysis: A 5-Year Cohort
            Study

Miguel, Jair Baptista; Matos, Jorge Paulo Strogoff de; Lugon, Jocemir Ronaldo

doi:10.5935/abc.20170026

Cited by 10 publications

(13 citation statements)

References 35 publications

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“…As our patients had continued hemodialysis therapy for about 10 years at the observation start time, atherosclerosis might have already presented at that time. Our results were supported by the report of Miguel showing that the persistence of low ABI was significantly associated with all‐cause mortality after adjustment for demographics, comorbidities, and laboratory variables among hemodialysis patents after 5‐year observation . The influence of serum magnesium level on atherosclerosis has been explained by several factors such as anti‐calcification, anti‐inflammation, antioxidation, and endothelial disfunction .…”

Section: Discussionsupporting

confidence: 84%

“…Our results were supported by the report of Miguel showing that the persistence of low ABI was significantly associated with all-cause mortality after adjustment for demographics, comorbidities, and laboratory variables among hemodialysis patents after 5-year observation. 12 The influence of serum magnesium level on atherosclerosis has been explained by several factors such as anti-calcification, [13][14][15] anti-inflammation, 16 antioxidation, 17 and endothelial disfunction. 18 Although we could find no direct relationship between serum magnesium levels and calcification and inflammation in our study, we could not exclude the possibility of the involvement of antioxidation and endothelial dysfunction in atherosclerotic formation by serum magnesium.…”

Section: Discussionmentioning

confidence: 99%

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The relationship between serum magnesium levels and mortality in non‐diabetic hemodialysis patients: A 10‐year follow‐up study

Shimohata

Yamashita

Ohgi

et al. 2019

Hemodialysis International

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Introduction Recently, although there are many reports showing that serum magnesium concentration is a predictor of mortality in dialysis patients, the observation periods of those reports were of short duration, typically around 12 months. Thus, we investigated this relationship over a longer follow‐up period. Methods This retrospective, observational study included a total of 83 non‐diabetic hemodialysis patients. The follow‐up period was 120 months. Patients were divided into two groups, those with serum magnesium ≥2.5 mg/dL (Mg ≥2.5 mg/dL group) and serum magnesium <2.5 mg/dL (Mg <2.5 mg/dL group), and Kaplan‐Meier analysis and Cox proportional hazards analysis were conducted. In addition to the above analysis, single and multiple regression analysis were performed at baseline to reveal the relationship between serum magnesium and clinical parameters. Findings During the follow‐up period, 31 out of 83 patients died. Kaplan‐Meier analysis showed a significantly higher incidence of death in the Mg <2.5 mg/dL group (log‐rank test 4.951, P = 0.026). Multivariate Cox proportional hazards analysis showed a 62% decreased risk of mortality in the Mg ≥2.5 mg/dL group compared to the Mg <2.5 mg/dL group after adjustment for several confounding factors. Simple correlation coefficient analysis showed positive correlations of serum magnesium levels with serum creatinine, phosphorus, high‐density lipoprotein, ankle‐brachial index and KT/V, and a negative correlation with age. Multiple linear regression analysis showed that the ankle‐brachial index was the only parameter that had a positive and significant correlation with the serum magnesium level. Conclusion Our study demonstrated that higher serum magnesium levels were associated with improved survival in non‐diabetic hemodialysis patients.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

The relationship between serum magnesium levels and mortality in non‐diabetic hemodialysis patients: A 10‐year follow‐up study

Shimohata

Yamashita

Ohgi

et al. 2019

Hemodialysis International

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“…Although the association of ABI with mortality has been studied in some detail in dialysis patients, and both the ABI and TBI have been described in a cross‐sectional study of dialysis patients, there has been no comprehensive analysis looking at both the associations of ABI and TBI with mortality and MALE outcomes in dialysis patients. We found that TBI < 0.7 was also associated with a higher risk of mortality in dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

The association of the ankle‐brachial index, the toe‐brachial index, and their difference, with mortality and limb outcomes in dialysis patients

Prasad

Kamath

Ginsberg

et al. 2019

Hemodialysis International

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Introduction: The ankle‐brachial index (ABI) is the most common test to diagnose peripheral artery disease (PAD). In dialysis patients, the ABI may under‐diagnose PAD, due to a high prevalence of concomitant medial arterial calcification (MAC). The toe‐brachial index (TBI) is not as susceptible to misclassification by MAC. Taking the ABI and TBI together in the form of their difference, the ABI‐TBI, may provide a single measure for assessing both atherosclerosis and calcification. The relationship of these variables in dialysis patients has not been well studied. Methods: We identified 37 dialysis patients referred for vascular studies between 2009 and 2017 in the San Diego Veterans Administration Medical Center (SDVAMC). The ABI and TBI were performed systematically for each patient, and TBI was performed regardless of ABI or waveform. We examined associations between ABI, TBI, and the difference between them (ABI‐TBI) with all‐cause mortality and major adverse limb events (MALE), which includes revascularizations and amputations. Findings: The mean age was 65 years and 30% were African American. All patients were men, reflecting the Veterans Administration population. There were 26 deaths during follow‐up and mortality was highest in patients who had low ABI and low TBI and least in those with high ABI and high TBI. Persons with TBI < 0.7 had an increased risk of all‐cause mortality. The ABI‐TBI, and the ABI itself, were not significantly associated with all‐cause mortality although the patterns were similar. Discussion: Although ABI may be an important initial risk stratification tool, the TBI may be a more informative predictor of mortality in dialysis patients. Strengths of this study include a high rate of MALE and deaths. The TBI, and the difference between ABI and TBI, should be studied further in a larger cohort of persons with advanced kidney disease.

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“…Since ABI may be influenced by hemodialysis, 10 all ABI values were obtained by a trained and experienced physician 10–30 minutes before hemodialysis and after 5 minutes’ rest in the supine position. The ABI values were measured once in each patient using the Bidop ES-100 V3 arterial doppler device (Hadeco, Kawasaki, Japan), which automatically and simultaneously acquires oscillometric BP measurements in both arms and ankles.…”

Section: Methodsmentioning

confidence: 99%

“… 12 Systolic BP (SBP) was measured twice at each site, in rapid succession and alternating, to obtain an average value. 10 Using the SBP ankle value the ABI was calculated as the ratio of ankle SBP / arm SBP . The ABI values were defined as follows: PAD present, abnormal ABI (<0.9 or >1.3) and PAD absent, normal ABI (0.9–1.3).…”

Section: Methodsmentioning

confidence: 99%

Prognostic Significance of Abnormal Ankle–Brachial Index Among Long-term Hemodialysis Patients in Kinshasa, the Democratic Republic of the Congo

Engole

Lepira

Nlandu

et al. 2021

Rambam Maimonides Med J

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Objective: Early identification of atherosclerosis using a non-invasive tool like ankle–brachial index (ABI) could help reduce the risk for cardiovascular disease among long-term hemodialysis patients. The study objective was to assess the frequency and impact of abnormal ABI as a marker of subclinical peripheral artery disease (PAD) in chronic hemodialysis patients. Methods: This was a historic cohort study of kidney failure patients on long-term hemodialysis for at least 6 months. The ABI, measured with two oscillometric blood pressure devices simultaneously, was used to assess subclinical atherosclerosis of low limb extremities. Abnormal ABI was defined as ABI <0.9 or >1.3 (PAD present). Survival was defined as time to death. Independent factors associated with abnormal ABI were assessed using multiple logistic regression analysis. Kaplan–Meier method (log-rank test) was used to compare cumulative survival between the two groups; a P value <0.05 was statistically significant. Results: Abnormal ABI was noted in 50.6% (n=43) of the 85 kidney failure patients included in the study; 42.4% (n=36) had a low ABI, and 8.2% (n=7) had a high ABI. Factors associated with PAD present were cholesterol (adjusted odds ratio [AOR], 1.02; 95% confidence interval [CI], 1.01–1.04; P=0.019), inflammation (AOR, 9.44; 95% CI, 2.30–18.77; P=0.002), phosphocalcic product (AOR, 6.25; 95% CI, 1.19–12.87; P=0.031), and cardiac arrhythmias (AOR, 3.78; 95% CI, 1.55–7.81, P=0.009). Cumulative survival was worse among patients with PAD present (log-rank; P=0.032). Conclusion: The presence of PAD was a common finding in the present study, and associated with both traditional and emerging cardiovascular risk factors as well as a worse survival rate than patients without PAD.

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Ankle-Brachial Index as a Predictor of Mortality in Hemodialysis: A 5-Year Cohort Study

Cited by 10 publications

References 35 publications

The relationship between serum magnesium levels and mortality in non‐diabetic hemodialysis patients: A 10‐year follow‐up study

The relationship between serum magnesium levels and mortality in non‐diabetic hemodialysis patients: A 10‐year follow‐up study

The association of the ankle‐brachial index, the toe‐brachial index, and their difference, with mortality and limb outcomes in dialysis patients

Prognostic Significance of Abnormal Ankle–Brachial Index Among Long-term Hemodialysis Patients in Kinshasa, the Democratic Republic of the Congo

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