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Updated: May 19, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Low ankle-brachial index and the development of rapid estimated GFR decline and CKD
Meredith C Foster1, Nimrta Ghuman, Shih-Jen Hwang
1National Heart, Lung, and Blood Institute's (NHLBI's) Framingham Heart Study, Framingham, MA, USA.
Insights
Low ankle-brachial index (ABI), a marker of atherosclerosis, is linked to a higher risk of rapid kidney function decline. This suggests systemic vascular disease predicts worsening kidney health.
Area of Science:
- Cardiology
- Nephrology
- Vascular Medicine
Background:
- Low ankle-brachial index (ABI) correlates with elevated serum creatinine.
- The association between low ABI and rapid estimated glomerular filtration rate (eGFR) decline, stage 3 chronic kidney disease (CKD), or microalbuminuria remains unclear.
Purpose of the Study:
- To investigate the association between low ABI and the development of rapid eGFR decline, incident stage 3 CKD, and incident microalbuminuria.
Main Methods:
- Prospective cohort study utilizing data from the Framingham Offspring cohort.
- Ankle-brachial index (ABI) categorized as normal, low-normal, and low (≤0.9).
- Estimated glomerular filtration rate (eGFR) calculated using CKD-EPI equation; microalbuminuria assessed via urinary albumin-creatinine ratio (UACR).
Main Results:
- Low ABI was significantly associated with a 3.60-fold increased odds of rapid eGFR decline after multivariable adjustment.
- A trend for increased odds of incident stage 3 CKD was observed with low ABI, though not statistically significant after full adjustment.
- Low ABI was associated with increased odds of microalbuminuria, but this association attenuated with further adjustment.
Conclusions:
- Low ABI is a significant predictor of rapid eGFR decline.
- The findings suggest that systemic atherosclerosis, indicated by low ABI, is associated with decreased kidney function.
- Further research may clarify the relationship between low ABI and CKD progression and microalbuminuria.
Background:
Low ankle-brachial index (ABI) is associated with increases in serum creatinine level. Whether low ABI is associated with the development of rapid estimated glomerular filtration rate (eGFR) decline, stage 3 chronic kidney disease (CKD), or microalbuminuria is uncertain.
Study Design:
Prospective cohort study.
Setting & Participants:
Framingham Offspring cohort participants who attended the sixth (1995-1998) and eighth (2005-2008) examinations.
Predictor:
ABI, categorized as normal (>1.1 to <1.4), low-normal (>0.9 to 1.1), and low (≤0.9).
Outcomes:
Rapid eGFR decline (eGFR decline ≥3 mL/min/1.73 m(2) per year), incident stage 3 CKD (eGFR <60 mL/min/1.73 m(2)), incident microalbuminuria.
Measurements:
GFR was estimated using the serum creatinine-based CKD-EPI (CKD Epidemiology Collaboration) equation. Urinary albumin-creatinine ratio (UACR) was determined based on spot urine samples.
Results:
During 9.5 years, 9.0% (232 of 2,592) experienced rapid eGFR decline and 11.1% (270 of 2,426) developed stage 3 CKD. Compared to normal ABI, low ABI was associated with 5.73-fold increased odds of rapid eGFR decline (95% CI, 2.77-11.85; P<0.001) after age, sex, and baseline eGFR adjustment; this persisted after multivariable adjustment for standard CKD risk factors (OR, 3.60; 95% CI, 1.65-7.87; P = 0.001). After adjustment for age, sex, and baseline eGFR, low ABI was associated with a 2.51-fold increased odds of stage 3 CKD (OR, 2.51; 95% CI, 1.16-5.44; P = 0.02), although this was attenuated after multivariable adjustment (OR, 1.68; 95% CI, 0.75-3.76; P = 0.2). In 1,902 free of baseline microalbuminuria, low ABI was associated with increased odds of microalbuminuria after adjustment for age, sex, and baseline UACR (OR, 2.81; 95% CI, 1.07-7.37; P = 0.04), with attenuation upon further adjustment (OR, 1.88; P = 0.1).
Limitations:
Limited number of events with low ABI. Outcomes based on single serum creatinine and UACR measurements at each examination.
Conclusions:
Low ABI is associated with an increased risk of rapid eGFR decline, suggesting that systemic atherosclerosis predicts a decrease in kidney function.
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