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Change in ankle-brachial index over time and mortality in diabetics with proteinuria

Sirin Jiwakanon1, Sharon Adler, Rajnish Mehrotra

  • 1Hatyai Hospital, Hatyai, Songkhla, Thailand.

Clinical Nephrology
|July 13, 2012
PubMed

Insights

In diabetic chronic kidney disease (CKD) patients, a low or decreasing ankle-brachial index (ABI) significantly predicts a higher risk of all-cause mortality. Routine ABI measurement aids in risk stratification for these individuals.

Area of Science:

  • Nephrology
  • Cardiology
  • Vascular Medicine

Background:

  • Peripheral arterial disease (PAD) is prevalent in diabetic chronic kidney disease (CKD).
  • Ankle-brachial index (ABI) abnormalities (low or high) are common in this population.
  • The prognostic significance of different ABI levels and changes is not well understood.

Purpose of the Study:

  • To investigate the association between baseline ABI and all-cause mortality in proteinuric diabetic CKD patients.
  • To determine if changes in ABI over time predict mortality in this cohort.
  • To evaluate the utility of ABI measurement for risk stratification in diabetic CKD.

Main Methods:

  • Prospective study of 167 proteinuric diabetic CKD patients.
  • Baseline ABI measurement and assessment of all-cause mortality over a mean follow-up of 40 months.
  • ABI change analysis in 75 subjects with normal baseline ABI over 23 months.

Main Results:

  • 41% of participants had abnormal baseline ABI (<0.9 or >1.3).
  • Low baseline ABI (<0.9) was associated with significantly higher all-cause mortality (HR: 2.23).
  • A decrease in ABI over time in initially normal ABI subjects strongly predicted mortality (adjusted HR: 7.41).

Conclusions:

  • Peripheral arterial disease is common and progresses rapidly in diabetic CKD.
  • Both low baseline ABI and a declining ABI are potent predictors of all-cause mortality.
  • Routine ABI measurement offers a simple method for risk stratification in diabetic CKD patients.

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