Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139089/1/jah31554.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139089/2/jah31554_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139089/3/jah31554-sup-0001-TableS1.pd

Appel, Lawrence J.

Budoff, Matthew

Chen, Jing

Feldman, Harold I.

Garimella, Pranav S.

Go, Alan S.

Hamm, L. Lee

He, Jiang

Kimmel, Stephen

Kusek, John W.

Lash, James P.

Mohler, Emile R.

Nessel, Lisa

Ojo, Akinlolu

Pan, Qiang

Rahman, Mahboob

Steigerwalt, Susan

Townsend, Raymond R.

Wright, Jackson T.

Xie, Dawei

Journal of the American Heart Association

English

PubMed


            Background
            
              The clinical implications of ankle‐brachial index (
              ABI
              ) cutpoints are not well defined in patients with chronic kidney disease (
              CKD
              ) despite increased prevalence of high
              ABI
              attributed to arterial stiffness. We examined the relationship of
              ABI
              with cardiovascular disease (
              CVD
              ) and all‐cause mortality among
              CKD
              patients.
            
          
          
            Methods and Results
            
              Three thousand six hundred twenty‐seven participants without clinical peripheral artery disease (
              PAD
              ) at baseline from the Chronic Renal Insufficiency Cohort Study were included.
              ABI
              was obtained per standard protocol and
              CVD
              events were confirmed by medical record adjudication. A U‐shaped association of
              ABI
              with
              PAD
              , myocardial infarction (
              MI
              ), composite
              CVD
              , and all‐cause mortality was observed. Individuals with an
              ABI
              between 1.0 and &lt;1.4 had the lowest risk of outcomes. Compared to participants with an
              ABI
              between 1.0 and &lt;1.4, multiple‐adjusted hazard ratios (95% confidence intervals) for those with an
              ABI
              of &lt;0.9, 0.9 to &lt;1.0, and ≥1.4 were 5.78 (3.57, 9.35), 2.76 (1.56, 4.88), and 4.85 (2.05, 11.50) for
              PAD
              ; 1.67 (1.23, 2.29), 1.85 (1.33, 2.57), and 2.08 (1.10, 3.93) for
              MI
              ; 1.51 (1.27, 1.79), 1.39 (1.15, 1.68), and 1.23 (0.82, 1.84) for composite
              CVD
              ; and 1.55 (1.28, 1.89), 1.36 (1.10, 1.69), and 1.00 (0.62, 1.62) for all‐cause mortality, respectively.
            
          
          
            Conclusions
            
              This study indicates that
              ABI
              &lt;1.0 was related to risk of
              PAD
              ,
              MI
              , composite
              CVD
              , and all‐cause mortality whereas
              ABI
              ≥1.4 was related to clinical
              PAD
              . These findings suggest that
              ABI
              cutpoints of &lt;1.0 or ≥1.4 for diagnosing
              PAD
              and
              ABI
              &lt;1.0 for
              CVD
              risk stratification should be further evaluated among
              CKD
              patients.
            
          </jats:sec

Jing Chen

Emile R. Mohler

Pranav S. Garimella

L. Lee Hamm

Dawei Xie

Stephen Kimmel

Raymond R. Townsend

Matthew Budoff

Qiang Pan

Lisa Nessel

Susan Steigerwalt

Jackson T. Wright

Jiang He

Lawrence J. Appel

Harold I. Feldman

Alan S. Go

John W. Kusek

James P. Lash

Akinlolu Ojo

Mahboob Rahman

null null

Crossref

Ankle Brachial Index and Subsequent Cardiovascular Disease Risk in Patients With Chronic Kidney Disease

Deep Blue Documents at the University of Michigan

The clinical implications of ankle-brachial index (ABI) cutpoints are not well defined in patients with chronic kidney disease (CKD) despite increased prevalence of high ABI attributed to arterial stiffness. We examined the relationship of ABI with cardiovascular disease (CVD) and all-cause mortality among CKD patients. Three thousand six hundred twenty-seven participants without clinical peripheral artery disease (PAD) at baseline from the Chronic Renal Insufficiency Cohort Study were included. ABI was obtained per standard protocol and CVD events were confirmed by medical record adjudication. A U-shaped association of ABI with PAD, myocardial infarction (MI), composite CVD, and all-cause mortality was observed. Individuals with an ABI between 1.0 and &lt;1.4 had the lowest risk of outcomes. Compared to participants with an ABI between 1.0 and &lt;1.4, multiple-adjusted hazard ratios (95% confidence intervals) for those with an ABI of &lt;0.9, 0.9 to &lt;1.0, and ≥1.4 were 5.78 (3.57, 9.35), 2.76 (1.56, 4.88), and 4.85 (2.05, 11.50) for PAD; 1.67 (1.23, 2.29), 1.85 (1.33, 2.57), and 2.08 (1.10, 3.93) for MI; 1.51 (1.27, 1.79), 1.39 (1.15, 1.68), and 1.23 (0.82, 1.84) for composite CVD; and 1.55 (1.28, 1.89), 1.36 (1.10, 1.69), and 1.00 (0.62, 1.62) for all-cause mortality, respectively. This study indicates that ABI &lt;1.0 was related to risk of PAD, MI, composite CVD, and all-cause mortality whereas ABI ≥1.4 was related to clinical PAD. These findings suggest that ABI cutpoints of &lt;1.0 or ≥1.4 for diagnosing PAD and ABI &lt;1.0 for CVD risk stratification should be further evaluated among CKD patients

Mohler, Emile R

Garimella, Pranav S

Hamm, L Lee

Townsend, Raymond R

Wright, Jackson T

Appel, Lawrence J

Feldman, Harold I

Go, Alan S

Kusek, John W

Lash, James P

eScholarship - University of California

http://dx.doi.org/10.1161/JAHA.116.003339

Ankle Brachial Index and Subsequent Cardiovascular Disease Risk in Patients With Chronic Kidney Disease

Abstract

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Crossref

Deep Blue Documents at the University of Michigan

eScholarship - University of California