Relationship between Ankle-Brachial Index and Chronic Kidney Disease in Hypertensive Patients with No Known Cardiovascular Disease

Abstract

Both decreased GFR and albuminuria are associated with an elevated prevalence of peripheral artery disease. However, the combined effects of these alterations previously were not evaluated. Patients with hypertension and with no known vascular disease (n ‫؍‬ 955; mean age 66 yr; 56% male) were selected from internal medicine outpatient clinics throughout Spain. Cardiovascular risk factors, urinary albumin excretion, and the ankle-brachial index (ABI) were assessed in all participants. GFR was estimated according to the Cockroft-Gault equation. Of the study population, 62% had diabetes, 23.8% had a GFR <60 ml/min per 1.73 m 2 , and 43.8% had albuminuria. The prevalence of ABI <0.9 was greater in patients with a GFR <60 ml/min per 1.73 m 2 (37.4 versus 24.3%; P < 0.0001) and in those who had albuminuria (32.2 versus 23.3%; P ‫؍‬ 0.001). In patients with both alterations, the prevalence of ABI <0.9 was 45.7%. Multivariate analysis indicated that the factors that were associated independently with low ABI were age (odds ratio P atients with peripheral artery disease (PAD) of the lower limbs, whether symptomatic or not, have an elevated risk for cardiovascular disease and premature death (1,2). Early detection of PAD identifies a group of patients who would benefit from aggressive cardiovascular risk factor modification and from antiplatelet therapy. Several factors have been associated with the development of PAD, among which are age, gender, diabetes, smoking habit, dyslipidemia, and hypertension. High BP is an important risk factor in the progressive deterioration of renal function and in the development of albuminuria, particularly in patients of advanced age. Although both a decreased GFR (3-7) and the presence of albuminuria (8,9) have been associated independently with an elevated prevalence of PAD, their combined effects were not evaluated previously. This is of considerable importance given that not only PAD but also chronic renal disease is additive, and both are independent risk factors for the development of cardiovascular disease (10,11). Their simultaneous presence characterizes a subgroup of patients who have very high risk for cardiovascular disease and could benefit from early diagnosis and treatment (12). The objective of the present study was to determine the association between the GFR and albuminuria with the presence of subclinical PAD of the lower limbs in a large population of hypertensive patients with no known cardiovascular disease.[ Materials and Methods PatientsParticipants in the Modificacion de le Estratificació n del Riesgo con el Indice Tobillo-brazo (MERITO) study were of both genders, were between the ages of 50 and 85 yr, and attended internal medicine outpatient clinics in hospitals throughout Spain. Each investigator was required to measure the ankle-brachial index (ABI) in 20 consecutive patients who attended the clinic; 10 had type 2 diabetes, and 10 did not have diabetes but had a risk for death from cardiovascular disease Ն3% over the next 10 yr, calculated according to the e...

Association between estimated glomerular filtration rate and peripheral arterial disease

“…Studies that calculated GFR using the Cockroft-Gault equation [28] or the Modification of Diet in Renal Disease formula [29] have demonstrated a high PAD prevalence of 37.4-41.9% in patients with eGFR < 60 mL/min/1.73 m 2 , as compared with 22.3-24.3% in patients with eGFR !60 mL/min/1.73 m 2 [12,30]. In this study, we obtained comparable results using a Japanese equation for estimating GFR, which was derived from a Japanese population study [21].…”

Prevalence of Peripheral Arterial Disease (PAD) in End Stage Renal Disease (ESRD) Patients on Hemodialysis: A Study from Central Nepal

“…Different studies had come with different prevalence of PAD in hemodialysis population. [12][13][14] The difference in prevalence between different series could be because of difference in study methodology and design.…”

Combined Effect of Chronic Kidney Disease and Peripheral Arterial Disease on All-Cause Mortality in a High-Risk Population

“…PAD is very common in the CKD population (GFR Ͻ60 ml/min) with prevalence rates of 24 to 37% (21)(22)(23). Both CKD and PAD share the same cardiovascular risk factors and are clinical manifestations of diffuse atherosclerosis.…”