Factors influencing pathological ankle-brachial index values along the chronic kidney disease spectrum: the NEFRONA study
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https://doi.org/10.1093/ndt/gfw039 |
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Title
Factors influencing pathological ankle-brachial index values along the chronic kidney disease spectrum: the NEFRONA studyAuthor (s)
Date
2017Publisher
Oxford University PressISSN
0931-0509; 1460-2385Bibliographic citation
David Arroyo, Angels Betriu, Joan Valls, Jose L. Gorriz, Vicente Pallares, Maria Abajo, Marta Gracia, Jose Manuel Valdivielso, Elvira Fernandez, on behalf of the investigators from the NEFRONA study; Factors influencing pathological ankle-brachial index values along the chronic kidney disease spectrum: the NEFRONA study. Nephrol Dial Transplant 2017; 32 (3): 513-520. doi: 10.1093/ndt/gfw039Type
info:eu-repo/semantics/articlePublisher version
https://academic.oup.com/ndt/article/32/3/513/3059407/Factors-influencing-pathol ...Version
info:eu-repo/semantics/publishedVersionSubject
Abstract
Background: The ankle-brachial index (ABI) is widely used to
diagnose subclinical peripheral artery disease (PAD) in the general
population, but data assessing its prevalence and related factors
in different chronic ... [+]
Background: The ankle-brachial index (ABI) is widely used to
diagnose subclinical peripheral artery disease (PAD) in the general
population, but data assessing its prevalence and related factors
in different chronic kidney disease (CKD) stages are scarce.
The aim of this study is to evaluate the prevalence and associated
factors of pathological ABI values in CKD patients.
Methods: NEFRONA is a multicentre prospective project that
included 2445 CKD patients from 81 centres and 559 non-CKD
subjects from 9 primary care centres across Spain. A trained
team collected clinical and laboratory data, performed vascular
ultrasounds and measured the ABI.
Results: PAD prevalence was higher in CKD than in controls (28.0
versus 12.3%, P < 0.001). Prevalence increased in more advanced
CKD stages, due to more patients with an ABI 1.4, rather than
0.9. Diabetes was the only factor predicting both pathological
values in all CKD stages. Age, female sex, carotid plaques, higher
carotid intima-media thickness, higher high-sensitivity C-reactive
protein (hsCRP) and triglycerides, and lower 25-hydroxi-vitamin
D were independently associated with an ABI 0.9. Higher phosphate
and hsCRP, lower low-density lipoprotein (LDL)-cholesterol
and dialysis were associated with an ABI 1.4. A stratified analysis
showed different associated factors in each CKD stage, with phosphate
being especially important in earlier CKD, and LDLcholesterol
being an independent predictor only in Sage 5D CKD.
Conclusions: Asymptomatic PAD is very prevalent in all CKD
stages, but factors related to a low or high pathological ABI differ,
revealing different pathogenic pathways. Diabetes, dyslipidaemia,
inflammation and mineral-bone disorders play a role in
the appearance of PAD in CKD. [-]
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Nephrol Dial Transplant (2017) 32: 513–520Rights
© The Author 2016. Published by Oxford University Press
on behalf of ERA-EDTA. All rights reserved.
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