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Abstract: TH-PO699

The Relationship of Change in Ankle Brachial Index with Mortality Among Individuals with CKD: The CRIC Study

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Dorans, Kirsten S., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • He, Hua, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Chen, Jing, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Dobre, Mirela A., Case Western Reserve University, Cleveland, Ohio, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Jaar, Bernard G., Johns Hopkins University and Nephrology Center of Maryland, Baltimore, Maryland, United States
  • Mehta, Rupal, Northwestern Univesrsity, Feinberg School of Medicine, Chicago, Illinois, United States
  • Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States
  • Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States
  • Rosas, Sylvia E., Joslin Diabetes Center, Boston, Massachusetts, United States
  • Srivastava, Anand, Northwestern Univesrsity, Feinberg School of Medicine, Chicago, Illinois, United States
  • He, Jiang, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States

Group or Team Name

  • On behalf of CRIC Study Principal Investigators
Background

Patients with chronic kidney disease (CKD) have an increased risk of peripheral arterial disease (PAD). Ankle-brachial index (ABI), a non-invasive measure of PAD, is a predictor of adverse events among individuals with CKD. In general populations, changes in ABI have been associated with mortality, but this association is not well understood among patients with CKD.

Methods

Prospective study of 2987 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study without clinical PAD at baseline, and with at least one follow-up ABI measurement (taken at annual study visits). ABI was obtained by standard protocol. The association of change in ABI and mortality was studied using Cox proportional hazards regression.

Results

We found U-shaped associations of average annual change in ABI and cumulative average ABI with all-cause mortality (p for non-linearity ≤0.0001). Compared to participants with average annual change in ABI of 0 to <0.02, individuals with average annual change in ABI <-0.02, -0.02 to <0, or ≥0.02 had multivariable-adjusted hazard ratios (95% CI) of 2.04 (1.57, 2.66), 1.25 (0.98, 1.58), and 1.68 (1.37, 2.05) for all-cause mortality, respectively. Compared to participants with cumulative average ABI between 1.0 and <1.4, multivariable-adjusted hazard ratios (95% CI) for those with cumulative average ABI of <0.9, 0.9 to <1.0, and ≥1.4 were 1.64 (1.33, 2.01), 1.22 (0.95, 1.55), and 1.29 (0.95, 1.75), respectively.

Conclusion

Findings from this study indicate that both larger decreases and increases in average annual changes in ABI (>0.02) were associated with higher risk of mortality. Monitoring changes in ABI over time may facilitate risk stratification for all-cause mortality among individuals with CKD.

Funding

  • NIDDK Support