JOURNAL ARTICLE
MULTICENTER STUDY

Predictive value of ankle-brachial index to all-cause mortality and cardiovascular mortality in Chinese patients with chronic kidney disease

Yong Wang, Xiaoyan Guo, Jue Li, Dayi Hu, Dongdong Zhao, Heng Ma, Qingjie Mou, Jing Liu, Yawei Xu
VASA. Zeitschrift Für Gefässkrankheiten 2012, 41 (3): 205-13
22565622

BACKGROUND: To investigate the predictive value of ankle-brachial index (ABI) for all-cause mortality and cardiovascular mortality in Chinese patients with chronic kidney disease (CKD).

PATIENTS AND METHODS: 1563 CKD patients were enrolled in the cohort and were followed up for about 3 years in China. CKD was defined as an eGFR less than 60 ml/min/1.73m(2). 573 participants were diagnosed with PAD using ABI <= 0.90. Their average age was 73.4 ±8.2 years.

RESULTS: During a median follow-up of 38 months, there were 1353 CKD patients with complete data. A total of 313 patients (161 with and 152 without PAD) died during follow-up. 184 deaths (99 with and 85 without PAD) were caused by cardiovascular disease (CVD). All-cause and CVD mortality of CKD patients with PAD was increased 2.2-fold and 2.4-fold compared with CKD patients without PAD. The hazard ratio (HR) of PAD for all-cause and CVD mortality was 2.15 (95 % CI: 1.66 - 2.79) and 2.51 (95 % CI: 1.80 - 3.50) respectively. Mortality of CKD patients significantly increased with decreasing ABI. That of CKD patients with ABI <= 0.4 was the highest (42.9 % and 28.6 %, respectively) in different ABI categories. Relative risks of all-cause and CVD mortality of CKD patients with ABI <= 0.4 were increased 3.479-fold (95 % CI: 2.076 - 5.830) and 4.960-fold (95 % CI: 2.644 - 9.302) respectively compared with those of patients with ABI > 1.0 and <= 1.4. Special models to evaluate the predictive value of ABI to mortality of CKD patients suggested that addition of ABI significantly increased the predictive value of the model for 3-year mortality compared with a model including conventional risk factors alone.

CONCLUSIONS: Low ankle-brachial index can predict increased mortality of chronic kidney disease patients. Addition of ankle-brachial index can significantly improve the prediction of 3-year mortality compared with conventional risk factors alone.

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