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Abstract: PO2110

The Accuracy of Current Ankle-Brachial Index and Toe-Brachial Index Diagnostic Criteria for Peripheral Artery Disease Among Patients with CKD

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Chen, Jing, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • He, Hua, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Starcke, Charlton Claire, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Guo, Yajun, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Geng, Siyi, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Chen, Chung-shiuan, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Mahone, Erin, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Laurent, Jodie R., Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Wiggin, Christina L., Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Mehta, Prakriti, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Pielet, Paige R., Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Batuman, Vecihi, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • He, Jiang, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
Background

Ankle-brachial index (ABI) less than or equal to 0.9 and toe-brachial index (TBI) less than or equal to 0.7 are used as diagnostic criteria for peripheral artery disease (PAD). The sensitivity and specificity of the ABI and TBI diagnostic criteria have not been evaluated in patients with chronic kidney disease (CKD).

Methods

We performed ABI, TBI, and doppler ultrasound among 100 patients with CKD using standard methods. Color doppler ultrasound, which has a high level of diagnostic performance with a sensitivity of 93% and a specificity of 95% for diagnosing PAD, was used as the reference standard. Doppler ultrasound diagnostic criteria were determined by multiple ultrasound features including reduction in luminal diameter, monophasic waveform, peak systolic velocity ratio (PSV ratio) >2.0, and presence of special broadcasting. Stenosis greater than or equal to 50% based on doppler ultrasound imaging was used to diagnose PAD. Sensitivity, specificity, positive predictive value, and negative predictive value were estimated. The areas under the curve (AUCs) for ABI and TBI were calculated.

Results

Participants with PAD were older, and more likely to be male and have a history of cardiovascular disease. The average estimated glomerular filtration rate and proteinuria were similar among participants with and without PAD. The sensitivity, specificity, positive predictive value, and negative predictive value were 15.6%, 88.3%, 20.8%, and 84.2% for ABI and 44.8%, 93.3%, 54.2%, and 90.5% for TBI, respectively. AUCs for ABI and TBI were 0.71 and 0.73, respectively.

Conclusion

These data indicate that current ABI and TBI diagnostic criteria have suboptimal accuracy in diagnosing PAD in CKD. New ABI and TBI diagnostic criteria with both optimal sensitivity and specificity need to be developed.

Funding

  • NIDDK Support