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Updated: Apr 3, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Interankle systolic blood pressure difference and renal outcomes in patients with chronic kidney disease
Szu-Chia Chen1,2,3,4, Yi-Chun Tsai1,3,4, Jiun-Chi Huang1,2
1Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.
Insights
Increased interankle blood pressure difference is linked to faster kidney function decline and higher risk of kidney failure in chronic kidney disease (CKD) patients. This finding highlights a new indicator for renal progression in CKD.
Area of Science:
- Nephrology
- Cardiology
- Vascular Medicine
Background:
- Interankle blood pressure (BP) difference is a known marker for peripheral artery disease and cardiovascular events.
- Its association with renal outcomes in chronic kidney disease (CKD) remains unevaluated.
Purpose of the Study:
- To investigate the relationship between interankle BP difference and the rate of renal function decline.
- To determine if interankle BP difference predicts progression to renal end points in patients with stage 3-5 CKD.
Main Methods:
- 144 patients with stage 3-5 CKD had simultaneous BP measurements in all four limbs.
- Renal function decline was assessed via estimated glomerular filtration rate (eGFR) slope.
- Renal end points included a 25% eGFR decline or initiation of dialysis.
Main Results:
- An elevated interankle systolic BP difference correlated with a worse eGFR slope.
- Increased interankle BP difference was associated with rapid renal progression.
- A higher interankle BP difference significantly increased the risk of progression to renal end points.
Conclusions:
- Interankle systolic BP difference is a significant predictor of rapid renal progression in CKD patients.
- This BP measurement may serve as a valuable tool for assessing renal prognosis in individuals with moderate to advanced CKD.
Aim:
Interankle blood pressure (BP) difference has been associated with peripheral artery disease and adverse cardiovascular outcomes. However, the relationship between interankle BP difference and renal outcomes in chronic kidney disease (CKD) has never been evaluated. The purpose of this study was to determine whether interankle BP difference is associated with the rate of renal function decline and progression to renal end points in patients with stage 3-5 CKD.
Methods:
We enrolled 144 patients with CKD from one regional hospital. The BP in four limbs was simultaneously measured using an ABI-form device. The decline in renal function was evaluated using an estimated glomerular filtration rate (eGFR) slope. Rapid renal progression was defined as an eGFR slope < -3 mL/min per 1.73 m(2) per year. The renal end points were defined as ≥ 25% decline in eGFR or commencement of dialysis during the follow-up period.
Results:
During a mean follow-up period of 3.1 years, 90 patients (62.5%) reached renal end points. Multivariate analysis showed that an increased interankle systolic BP difference (per 5 mmHg) was associated with a worse eGFR slope (regression β, -0.292; 95% confidence interval [CI], -0.482 to -0.102; P = 0.003), rapid renal progression (odds ratio, 1.189; 95% CI, 1.015-1.394; P = 0.032), and an increased risk of progression to renal end points (hazard ratio, 1.126; 95% CI, 1.052-1.204, P = 0.001).
Conclusion:
Interankle systolic BP difference was associated with rapid renal progression and progression to renal end points in patients with stage 3-5 CKD in our study.
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