Peripheral arterial disease and clinical risks in Taiwanese hemodialysis patients

Association between serum albumin and peripheral arterial disease in hypertensive patients

The authors aimed to evaluate the relationship of serum albumin with peripheral arterial disease (PAD) and investigate any possible effect modifiers in hypertensive patients. In the cross-sectional study, a total of 10,900 Chinese hypertensive patients aged ≥18 years were enrolled. The outcome was PAD, defined as an ankle-brachial index (ABI) <0.90 in either leg. The overall mean (SD) serum albumin was 46.8 (4.2) g/L. There were significant inverse associations of serum albumin with PAD (per SD increment; OR: 0.83; 95% CI: 0.72, 0.94). Compared with the lowest tertile (<45.1 g/L), the multivariate-adjusted ORs (95% CI) for participants in the middle tertile (45.1-48.2 g/L) and highest tertile (≥48.2 g/L) of serum albumin were 0.89 (95% CI: 0.67, 1.16) and 0.65 (95% CI: 0.47, 0.90), respectively. Conversely, lower albumin (<48.2 g/L) concentrations were associated with increased odds of PAD (OR: 1.45; 95% CI: 1.08-1.96) compared with higher concentrations. Furthermore, the albumin-PAD association was significantly stronger in males (OR: 2.08; 95% CI: 1.31, 3.30) than in females (OR: 1.06; 95% CI: 0.70, 1.58; p interaction = .024). In conclusion, among Chinese hypertensive adults, lower serum albumin was associated with the prevalence of PAD only in males but not in females.

Association between albumin and C-reactive protein and ankle-brachial index in haemodialysis

AIM

Peripheral artery occlusive disease (PAOD) is associated with increased rates of cardiovascular mortality, morbidity and hospitalization in patients undergoing dialysis. An ankle-brachial index (ABI) less than 0.9 has been used to diagnose PAOD. The aim of this study was to evaluate associations among inflammation, malnutrition and their interactions on the risk of PAOD.

METHODS

Two hundred and twenty-two haemodialysis patients (mean age 61.0 ± 11.7 years, 56.8% men) were enrolled and stratified into four groups according to median values of albumin (3.87 g/dL) and logarithm of C-reactive protein (CRP) (0.48 mg/L). Associations between the study groups and an ABI less than 0.9 were assessed using multiple logistic regression analysis. Receiver operating characteristic curves were constructed to predict an ABI less than 0.9.

RESULTS

A lower level of albumin and higher level of CRP were significantly associated with an ABI less than 0.9 in multivariate analysis (odds ratio, 5.688; 95% confidence interval, 1.369-23.626; P = 0.017) after adjusting for demographic, clinical, biochemical and medication data. The interaction between albumin and CRP in relation to an ABI less than 0.9 was significant in multivariate analysis (odds ratio, 1.797; 95% confidence interval, 1.258-2.568; P = 0.001). The areas under the curve for albumin, CRP and albumin + CRP for the prediction of ABI less than 0.9 were 0.311, 0.654 and 0.733, respectively.

CONCLUSION

Patients undergoing haemodialysis with a lower albumin level and higher CRP level have an increased risk of PAOD. A combination of malnutrition and inflammation may be associated with PAOD in haemodialysis patients.

Association between modified CHA2DS2-VASc Score with Ankle-Brachial index < 0.9

The ankle-brachial index (ABI) is a reliable diagnostic examination for peripheral arterial occlusive disease (PAOD). We previously reported CHADS₂ score was significantly correlated with PAOD. However, the association between CHA₂DS₂-VASc score and ABI < 0.9 is not evaluated in the literature. The aim of the present study was to investigate whether CHA₂DS₂-VASc score has a strong association with PAOD. We enrolled 1482 patients in this study. PAOD was defined as ABI < 0.9 in either leg. Vascular disease in CHA₂DS₂-VASc score was modified as vascular disease except PAOD. Of the 1482 subjects, the prevalence of ABI < 0.9 was 5.6%. Multivariate analysis showed that the increased age, decreased estimated glomerular filtration rate and increased modified CHA₂DS₂-VASc score (OR, 1.764; p < 0.001) were independent associated with ABI < 0.9. In addition, the percentage of ABI < 0.9 in patients with modified CHA₂DS₂-VASc score of 0, 1, and <2 were 0%, 0.9%, and 0.7%, respectively (All < 1%). Our study demonstrated modified CHA₂DS₂-VASc score was significantly associated with ABI < 0.9. Calculation of modified CHA₂DS₂-VASc score might be useful in identifying patients with PAOD and in stratifying the risk of PAOD in non-AF patients.

Prevalence of Asymptomatic Peripheral Arterial Disease and Related Risk Factors in Younger and Elderly Patients in Taiwan

We determined the prevalence of asymptomatic peripheral arterial disease (PAD) and cardiovascular risk factors in Taiwan. Ambulatory participants (n = 1915) without symptoms of PAD were enrolled (mean age of 61.2 years). The ankle-brachial index (ABI) was used to detect the PAD (ABI < 0.90). The overall prevalence of asymptomatic PAD was 5.4% (2.8% in the younger participants [<65 years of age, n = 1021] and 8.4% in the elderly participants [≥65 years of age, n = 894]). Younger participants with asymptomatic PAD had a significantly higher rate of hypertension (55.2% vs 30%) and obesity (31% vs 13.3%) than those without asymptomatic PAD ( P < .05). Elderly participants with asymptomatic PAD had a significantly higher rate of diabetes mellitus (36% vs 21.2%) and hypertension (69.3% vs 55.4%) than those without asymptomatic PAD ( P < .05). Asymptomatic PAD is prevalent among elderly Taiwanese individuals. Overall, age was the strongest risk factor for the development of asymptomatic PAD.

Comparing Survival between peritoneal dialysis and hemodialysis patients with subclinical peripheral artery disease: a 6-year follow-up

Peripheral artery disease (PAD) is known to be an increased mortality risk in patients with end-stage renal disease (ESRD). The aim of this study was to compare patient survival between patients with subclinical PAD undergoing peritoneal dialysis (PD) and hemodialysis (HD). Subclinical peripheral artery was defined as an ankle-brachial index of less than 0.9. This study was conducted from April 2005, and the observation period ended on 30 June 2011. At the end of the follow-up, the status of all patients was assessed and data on mortality were obtained for the entire cohort. A total of 91 patients (61 HD and 30 PD) were included for analyses in this study. Mortality rate was 60.0% (18/30) for PD and 52.5% (32/61) for HD. Kaplan-Meier estimate demonstrate that PD patients had a higher mortality rate than those underwent HD (log-rank p = 0.0039). Cox regression model demonstrated that PD was an independent predictor for further mortality in ESRD patients with subclinical peripheral artery disease.(p = 0.012, HR: 1.776, 95% CI: 1.136-2.775). In multivariate analysis, the HD group still had a greater survival than PD group (p = 0.005, HR:1.916, 95% CI: 1.218-3.015). In patients with subclinical peripheral artery disease, the patient survival is better in HD patients as compared with PD patients.

Prevalence and risk factors associated with peripheral artery disease in elderly patients undergoing peritoneal dialysis

BACKGROUND

Rapid growth of the elderly peritoneal dialysis (PD) population is posing a special challenge for renal teams. Peripheral artery disease (PAD) has been reported to be an independent predictor of cardiovascular and all-cause mortality in hemodialysis patients. However, the prevalence and associated risk factors for PAD in elderly PD patients have not yet been fully investigated.

METHODS

A total of 69 elderly PD patients were included in the present study. PAD was defined as either an ankle-brachial index < 0.9 or a history of intermittent claudication, lower-limb amputation, foot ulcers, or gangrene. On enrollment, clinical and biochemical characteristics were collected.

RESULTS

The overall prevalence of PAD was 31.9%. Compared with non-PAD patients, PAD patients were significantly older and more likely to be female and have longer PD duration and lower diastolic blood pressure (P < 0.001, = 0.002, 0.018, and 0.007, respectively). Serum albumin level (P < 0.001) and residual renal Kt/V value (P < 0.001) were significantly lower, but the serum C-reactive protein level (P = 0.005) was significantly higher, in PAD patients compared with non-PAD patients. Logistic regression analysis showed that serum albumin level (odds ratio = 1.485, P = 0.040) and residual renal Kt/V value (odds ratio = 1.725, P = 0.016) were independently associated with PAD.

CONCLUSION

A high prevalence of PAD appeared among elderly PD patients in Macao. Serum albumin level and residual renal Kt/V value were independently related to PAD.