血液透析患者におけるankle-brachial blood pressure index(ABI)が生命予後および死因に与える影響

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  • Influence of ankle-brachial blood pressure index(ABI) on mortality and cause of death
  • ケツエキ トウセキ カンジャ ニ オケル ankle-brachial blood pressure index(ABI)ガ セイメイ ヨゴ オヨビ シイン ニ アタエル エイキョウ

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Clinically, the ankle-brachial blood pressure index (ABI) has been widely used to screen for subclinical peripheral artery disease (PAD). PAD is a common complication in hemodialysis patients. In the present study, we investigated the association between the ABI and long-term (maximum of 6 years) mortality among hemodialysis patients and the causes of death. A total of 117 patients receiving maintenance hemodialysis who underwent an ABI examination in 2005 were enrolled. Patients with an ABI of less than 0.9 were considered as the ABI<0.9 group, while those with an ABI of more than 0.9 in both legs were considered as the ABI>0.9 group. Nineteen patients (16.2%) were included in the ABI<0.9 group. The serum albumin and creatinine levels were lower, the serum c-reactive protein level was higher, and the hemoglobin level was lower in the ABI<0.9 group than in the ABI>0.9 group (3.6±0.3g/dL vs. 3.8±0.3g/dL [p=0.002], 9.7±1.8mg/dL vs. 11.8±2.5mg/dL [p<0.001], 0.8±1.3mg/dL vs. 0.2±0.7mg/dL [p=0.003], and 9.6±1.1g/dL vs. 10.2±1.0g/dL [p=0.021], respectively). Multivariate Cox analysis identified an ABI<0.9, a male gender, a low level of serum creatinine, a low level of hemoglobin, and the presence of diabetes mellitus as independent predictors of mortality (p<0.001, p=0.006, p=0.002, p=0.041, and p=0.005, respectively). Infection was the most frequently observed cause of death in the ABI<0.9 group, and was more prevalent in the ABI<0.9 group (6/19) than in the ABI>0.9 group (4/98, p<0.001). An ABI<0.9 was an independent risk factor for mortality among hemodialysis patients. Infection was significantly more prevalent in the ABI<0.9 than in the ABI>0.9 group.

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