Document Detail


Impact of brachial-ankle pulse wave velocity and ankle-brachial blood pressure index on mortality in hemodialysis patients.
MedLine Citation:
PMID:  16183424     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulse wave velocity (PWV) and ankle-brachial blood pressure index (ABPI) are markers for atherosclerosis, and each predicts mortality in patients undergoing hemodialysis. However, there have been no studies in the past that compared head-to-head the clinical validity of these 2 parameters. Compared with conventional aortic PWV, brachial-ankle PWV (baPWV) is considered simple and thereby easily applicable to clinical use. METHODS: To clarify the relationship between baPWV and ABPI and assess their prognostic values, we analyzed 785 hemodialysis patients with a mean age of 60.2 +/- 12.5 (SD) years for whom ABPI and baPWV at baseline had been measured simultaneously and who were followed up for 33.8 +/- 10.8 months. RESULTS: Of 785 patients, 131 deaths were recorded. In Kaplan-Meier analysis, all-cause mortality was progressively and significantly greater from the lowest quartile of baPWV onward (log-rank test, 41.8; P < 0.001). However, in Cox proportional hazards analysis, the impact of baPWV was insignificant when ABPI was included as a covariate. ABPI maintained strong predictive power in this model. When patients who had advanced peripheral arterial occlusive disease (ABPI < 0.9) were excluded from analysis, patients with the highest quartile of baPWV had significantly increased hazard ratios of all-cause (hazard ratio, 4.08; 95% confidence interval, 1.46 to 11.43; P < 0.007) and cardiovascular (hazard ratio, 7.03; 95% confidence interval, 1.49 to 33.08; P < 0.014) mortality. The predictive power of baPWV in this population was independent from other covariates associated with atherosclerotic disorders. CONCLUSION: In a head-to-head comparison, ABPI, but not baPWV, showed strong power in predicting the mortality of hemodialysis patients. However, baPWV was useful to pick a high-risk population in patients with ABPI greater than 0.9. Thus, screening hemodialysis patients by means of baPWV and ABPI provides complementary information in identifying a high-risk population.
Authors:
Tokuyuki Kitahara; Kumeo Ono; Akiyasu Tsuchida; Hironobu Kawai; Masahiko Shinohara; Yoshitaka Ishii; Hikaru Koyanagi; Toshiharu Noguchi; Takayuki Matsumoto; Tetsuo Sekihara; Yukiyasu Watanabe; Hideo Kanai; Hideki Ishida; Yoshihisa Nojima
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  46     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-26     Completed Date:  2005-11-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  688-96     Citation Subset:  IM    
Affiliation:
Department of Medicine and Clinical Science, Gunma Graduate School of Medicine, Maebashi, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Ankle
Arm
Arteriosclerosis / complications,  physiopathology*
Blood Flow Velocity*
Blood Pressure*
Comorbidity
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic / complications,  physiopathology*,  therapy
Kidney Transplantation
Male
Middle Aged
Mortality*
Pulse
Renal Dialysis*
Smoking

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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