Atherosclerotic Risk Factors Among Ankle-Brachial Index and Toe-Brachial Index in Peritoneal Dialysis Patients

Abstract

Background. Atherosclerotic vascular change affecting the lower extremities is the most common peripheral vascular disease. Ankle-brachial index (ABI) and toe-brachial index (TBI) are common, non-invasive diagnostic tests for atherosclerosis in the lower extremities. Peritoneum is a vascular-based structure. The use of glucose-based hyperosmolar solutions for PD patients results in a significant increase in blood glucose load and can be considered atherogenic. The association between ABI or TBI values and peritoneal function in patients undergoing peritoneal dialysis remains unclear. We presumed that the risk factors for atherosclerosis in large and small vessels may differ. Methods. A total of 146 peritoneal dialysis patients, 41 males and 105 females (119 without diabetes and 27 with diabetes), received peritoneal dialysis for more than four months. Patients who had dialysis-related peritonitis within six months prior to this study were excluded. The ABI or TBI was determined using an automated, non-invasive, waveform analysis device. Results. The ABI value correlated positively with mean arterial pressure and TBI value. The TBI value correlated positively with ABI value and inversely with fasting serum glucose and serum total cholesterol concentrations. Peritoneal function was not correlated with ABI or TBI. Conclusion. This cross-sectional study demonstrated that risk factors in peritoneal dialysis patients for atherosclerosis in large vessels and small vessels differed. Interestingly, peritoneal function test is not associated with ABI or TBI value. However, further investigation of the association between ABI or TBI value and cardiovascular events is required for this patient group.

The association of very-low-density lipoprotein with ankle-brachial index in peritoneal dialysis patients with controlled serum low-density lipoprotein cholesterol level

“…In the Reduction of Atherothrombosis for Continued Health registry, PAD was observed with polyvascular disease [7]. The risk factors for PAD are diabetes mellitus (DM), age, and serum albumin, triglyceride (TG) and serum cholesterol levels [2,6,8]. Although PAD is prevalent in PD patients, it remains to be clarified which factors affect the progression of atherosclerosis and the development of PAD in PD patients.…”

Current guidelines in peritoneal dialysis – Part II

“…A TBI (which is diagnostic if < 0.6) may be indicated in those cases 144,145 . This tool has been validated for the diagnosis of PAD in PD; still studies concerning its sensitivity and specificity, clinical performance (vs. doppler or angiography), and predictive value for vascular events and complications remain to be carried out 146 .…”