Pathological ankle-brachial index in dialysispatients
Background. Patients in dialysis have an increased risk of cardiovascular disease and death. The purpose of this study was to evaluate the prevalence of pathologic ankle-brachial index (ABI) in a hemodialysis population at Oslo University Hospital Ullevål.
Material and methods. For measurement of the ankle- and brachial-blood pressure, we used a Doppler probe and a blood pressure cuff. The measurements were done 1-2 hours into the dialysis. ABI <0,9 was associated with occlusive arterial disease and ABI >1,3 was associated with incompressible arteries (mediasclerosis). A population of 78 hemodialysis patients was examined, and information about previous cardiovascular disease, diabetes mellitus, claudicatio intermittens, laboratory results and clinical data were collected.
Results. The prevalence of pathologic ABI, (< 0,9 or > 1,3), in the dialysis population was about four to six times higher than in the general population. Pathologic ABI was associated with previous cardiovascular disease. ABI > 1,3 and suspected mediasclerosis was more prevalent in dialysispatients with diabetes mellitus. There were about six times more reported claudicatio intermittens among the dialysis patients compared to the general population (older than 60 years). We did not find any correlation between pathologic ABI and traditional riskfactors for cardiovascular disease such as lipids and blood pressure or kidney specific risk factors such as quality of dialysis, uremic control, renal anemia or serum beta2-microglobulin.
Conclution. We found a high prevalence of peripheral arterial disease based on ankle-brachial index among dialysis patients. Claudicatio intermittens had low sensitivity and specificity in predicting peripheral arterial disease in the dialysis patients. The ankle-brachial index is a good, simple, inexpensive and non-invasive screening-test for revealing peripheral arterial disease.