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Titolo Ankle-brachial index, vascular calcifications and mortality in dialysis patients
Autore Teresa Adragao, Ana Pires, Patrıcia Branco, Rui Castro, Ana Oliveira, Cristina Nogueira, Joaquim Bordalo, Jose´ Dias Curto and Mateus Martins Prata
Referenza Nephrol Dial Transplant (2012) 27: 318–325

Background. The ankle-brachial index (ABI) is a noninvasive method to evaluate peripheral artery disease (PAD). ABI1.3 is a false negative caused by noncompressible arteries. The aim of this study is to evaluate the association between ABI with vascular calcifications (VC) and with mortality, in haemodialysis (HD) patients.

Methods. We studied 219 HD patients (60% male; 20% diabetic). At baseline, ABI was evaluated by a Doppler device. VCs were evaluated by two methods: the abdominal aorta calcification score (AACS) in a lateral plain X-ray of the abdominal aorta and the simple vascular calcification score (SVCS) in plain X-rays of the pelvis and hands. VC were also classified by their anatomical localization in main vessels (aorta and iliac-femoral axis) and in peripheral or distal vessels (pelvic, radial or digital). The cutoff values for the different VC scores in relation with ABI were determined by receiver operating characteristic curve analysis. Biochemical parameters were time averaged for the 6 months preceding ABI evaluation.

Results. An ABI1.3 or a normal ABI were found, respectively, in 90 (41%), in 42 (19%) and in 87 (40%) patients. AACS _6 and SVCS >3 were found, respectively, in 98 (45%) and 95 (43%) patients. The adjusted odds ratio (OR) for having an ABI1.3 was 4.2 (P ¼ 0.003) for pelvic CS and 3.7 (P ¼ 0.006) for hand CS _2. During an observational period of 28.9 months, all-cause and cardiovascular mortality occurred, respectively, in 50 (23%) and in 29 (13%) patients. Adjusting for age, diabetes, P levels, HD duration and cardiovascular disease at baseline, an ABI1.3 (HR ¼ 2.7, P ¼ 0.038) were associated with all-cause mortality; an ABI1.3 (HR ¼ 5.1, P ¼ 0.028) were associated with cardiovascular mortality.

Conclusions. Both low and high ABI were independent predictors of all-cause and cardiovascular mortality. VC in main arteries were associated with an ABI1.3. ABI is a simple and noninvasive method that allows the identification of high cardiovascular risk patients.

Data 03.12.2012
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