A reconciling criterion for early detection of asymptomatic PAD in HD patients

Abstract

Peripheral arterial disease (PAD), an important manifestation of systematic atherosclerosis, is common in hemodialysis (HD) patients, while usually underdiagnosed because most patients were asymptomatic. Some evidence indicated that the currently accepted criteria of ankle-brachial index (ABI) for clinical diagnosis of PAD result in poor sensitivity in HD patients. Other evidence indicated a necessity on using a reconciling criterion of ABI in HD population. This study therefore examined the PAD incidence and medical conditions in a cohort of maintenance HD patients with intermediate ABI (in 0.9–1) compared to those with high ABI (1–1.3) and with abnormal ABI (≤0.9). The Cox regression analysis on our cohort of HD patients showed that patients with intermediate ABI had significantly higher PAD incidence than those with high ABI (hazard ratio [95% confidence interval]: 4 [1.9–8.4]). The distribution of common medical conditions related to PAD, e.g., diabetes mellitus, cerebrovascular disease, body mass index, fasting blood sugar, and triglyceride, was significantly different between patients with intermediate ABI and high ABI, while no significant difference was observed between those with intermediate ABI and abnormal ABI. The results suggested that an ABI cutoff point of 1, instead of the conventionally used 0.9, could be considered for earlier detection of asymptomatic PAD and atherosclerosis prevention in HD patients.

Keywords

• asymptomatic
• ankle-brachial index
• hemodialysis
• peripheral arterial disease