Related Experiment Video
Updated: May 23, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Abnormal Ankle-Brachial Index and Risk of Cardiovascular and all-cause mortality in Patients With Chronic Kidney
Mohammad Hazique1, Arihant Surana2, Kunal N Patel3
1From the Department of Internal Medicine, Vassar Brothers Medical Center/Nuvance Health, Poughkeepsie, NY.
Insights
Abnormal ankle-brachial index (ABI) values predict cardiovascular and all-cause mortality in chronic kidney disease (CKD) patients. Both low (<0.9) and high (≥1.3) ABI levels indicate increased mortality risk, especially in hemodialysis patients.
Area of Science:
- Nephrology
- Cardiology
- Vascular Medicine
Background:
- Chronic kidney disease (CKD) is a significant global health issue, increasing the risk of cardiovascular (CV) and all-cause mortality.
- The ankle-brachial index (ABI) is a key non-invasive indicator for peripheral arterial disease (PAD).
Purpose of the Study:
- To evaluate if abnormally low or high ABI values independently predict CV and all-cause mortality in CKD patients.
- To assess these predictions in both dialysis-dependent and non-dialysis CKD populations.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched PubMed, Cochrane, and Google Scholar databases up to September 2024 for relevant cohort studies.
- Analyzed data using random-effects models with subgroup analyses for patient characteristics and study design.
Main Results:
- Included ten cohort studies with 13,378 participants; normal ABI defined as 0.9–1.3.
- Low ABI (<0.9) significantly increased CV mortality (HR=2.23) and all-cause mortality (HR=1.78).
- High ABI (≥1.3) significantly increased CV mortality (HR=2.77) and all-cause mortality (HR=1.49).
- Abnormal ABI overall linked to higher all-cause (HR=1.74) and CV mortality (HR=2.34).
- Hemodialysis patients and studies in Asia showed higher mortality risks.
Conclusions:
- Abnormal ABI values exhibit a U-shaped association with mortality in CKD patients.
- ABI is a strong predictor of CV and all-cause mortality, particularly in hemodialysis patients.
- ABI measurement is a valuable screening tool for prognostication in CKD patients.
Background:
Chronic kidney disease (CKD) is a global health concern associated with an elevated risk of cardiovascular (CV) and all-cause mortality. The ankle-brachial index (ABI), a noninvasive diagnostic tool, is widely recognized for detecting peripheral arterial disease. This meta-analysis aims to assess whether abnormally low or high ABI values independently predict CV and all-cause mortality in CKD patients, including those on hemodialysis.
Methods:
A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Cochrane, and Google Scholar databases through September 2024 to identify studies on abnormal ABI and mortality outcomes in CKD patients with or without hemodialysis. Data was analyzed with random-effects models, and subgroup analyses evaluated variations by patient characteristics, region, sample size, and follow-up duration.
Results:
The analysis included 10 cohort studies comprising 13,378 participants. ABI values between 0.9 and 1.3 were defined as normal. Individuals with abnormally low ABI (<0.9) demonstrated a significantly higher incidence in CV mortality [hazard ratio (HR) = 2.23; confidence interval (CI), 1.75-2.83) and all-cause mortality (HR = 1.78; CI, 1.55-2.05). Those with high ABI ≥1.3 were associated with a 2.77-fold increase in CV mortality (HR = 2.77; CI, 1.74-4.41) and a 1.49 higher risk of all-cause mortality (HR = 1.49; CI, 1.09-2.02). Overall, abnormal ABI values were linked to a 1.74 higher risk of all-cause mortality (HR = 1.74; CI, 1.54-1.96) and a 2.34-fold increase in CV mortality (HR = 2.34; CI, 1.93-2.85). Subgroup analyses revealed higher mortality risks in hemodialysis patients compared with nondialysis CKD patients and in studies conducted in Asia.
Conclusions:
Abnormal ABI values show a U-shaped relationship with mortality, serving as strong predictors of CV and all-cause mortality in CKD patients, particularly those on hemodialysis. Since CV and all-cause mortality are high in CKD patients, these findings suggest that ABI measurement is a useful screening technique to assist in prognosticating such patients. Further studies are warranted to validate these findings and to better understand the prognostic utility of ABI across different CKD stages, including both dialysis-dependent and nondialysis CKD patients.
More Related Videos
08:42Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
14:52Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication
Published on: December 11, 2013
Related Concept Videos
01:33Hormonal Regulation
01:45Kidney Structure
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...