Abstract
Peripheral artery occlusive disease and vascular calcification are highly prevalent in hemodialysis (HD) patients, however the association of the combination of ankle-brachial index (ABI) and aortic arch calcification (AoAC) with clinical outcomes in patients undergoing HD is unknown. In this study, we investigated whether the combination of ABI and AoAC is independently associated with overall and cardiovascular mortality in HD patients. The median follow-up period was 5.7 years. Calcification of the aortic arch was assessed by chest X-ray. Forty-seven patients died including 24 due to cardiovascular causes during the follow-up period. The study patients were stratified into four groups according to an ABI < 0.95 or ≥0.95 and an AoAC score of >4 or ≤4 according to receiver operating characteristic curve. Those with an ABI < 0.95 and AoAC > 4 (vs. ABI ≥ 0.95 and AoAC score ≤ 4) were associated with overall (hazard ratio [HR], 4.913; 95% confidence interval [CI], 1.932 to 12.497; p = 0.001) and cardiovascular (HR, 3.531; 95% CI, 1.070 to 11.652; p = 0.038) mortality in multivariable analysis. The combination of a low ABI and increased AoAC was associated with increased overall and cardiovascular mortality in patients undergoing HD.
Highlights
Peripheral artery occlusive disease (PAOD) is highly prevalent in hemodialysis (HD) patients[1,2], and the ankle-brachial index (ABI) is a simple and noninvasive method that can be used to identify PAOD
Of the 197 included patients, we stratified the patients into four groups according to an ABI < 0.95 or ≥0.95 and a median aortic arch calcification (AoAC) score of >4 or ≤4 according to receiver operating characteristic (ROC) curve
In this study we evaluated the association between a combination of ABI and AoAC and clinical outcomes in patients undergoing HD
Summary
Peripheral artery occlusive disease (PAOD) is highly prevalent in hemodialysis (HD) patients[1,2], and the ankle-brachial index (ABI) is a simple and noninvasive method that can be used to identify PAOD. We previously reported an association between a low ABI and vascular access failure[6]. Vascular calcification is very common in patients with end-stage renal disease, and especially in those undergoing HD9. Aortic arch calcification (AoAC) on a chest X-ray may represent total AoAC, and it has been associated with cardiovascular and all-cause mortality among patients with end-stage renal disease[12,13]. Previous studies have confirmed the relationship between vascular calcification and atherosclerosis in chronic renal failure patients[14,15]. No previous studies have evaluated the association between the combination of ABI and AoAC and clinical outcomes in patients undergoing HD. The aim of this study was to assess whether the combination of ABI and AoAC is independently associated with overall and cardiovascular mortality in patients undergoing HD.
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