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Kidney Week

Abstract: PO2359

Longitudinal Ankle Brachial Index and Risk of CKD Progression

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Dorans, Kirsten S., 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
  • Li, Xingyan, 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
  • Cohen, Jordana B., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, 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
  • Horwitz, Edward J., MetroHealth Medical Center, Cleveland, Ohio, United States
  • Jaar, Bernard G., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States
  • Mehta, Rupal, Northwestern University Department of Medicine, Chicago, Illinois, United States
  • Rosas, Sylvia E., Joslin Diabetes Center, Boston, Massachusetts, United States
  • Srivastava, Anand, Northwestern University Department of Medicine, Chicago, Illinois, United States
  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • He, Jiang, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States

Group or Team Name

  • CRIC Study Investigators
Background

Individuals with chronic kidney disease (CKD) are more likely than the general population to have low or high ankle brachial index (ABI). Low ABI is a predictor of adverse outcomes in CKD, but the relationship of ABI with renal outcomes in CKD is not well studied. As ABI is a simple noninvasive measure, it is important to better understand how ABI relates to CKD progression.

Methods

We carried out a prospective study of 3216 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study without clinical peripheral arterial disease. We used Cox proportional hazards regression to test the associations of baseline ABI and of cumulative average ABI with risk of CKD progression [50% reduction in estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD)] and with risk of ESRD, adjusting for important confounding factors. ABI was measured at annual visits. The shapes of the relationships of exposures with outcomes were assessed with restricted cubic splines.

Results

At baseline, average age was 57.8 years and average eGFR was 44.8 ml/min/1.73m2. During follow-up, 1297 individuals had CKD progression (median follow-up 6.9 years, 7 ABI measurements) and 1049 developed ESRD (median follow-up 10.8 years, 6 ABI measurements). In multivariable-adjusted models, there were U-shaped associations of baseline ABI with CKD progression and with ESRD (p for curves <0.001). In models adjusted for baseline ABI, similar U-shape relationships were observed for the associations of cumulative average ABI with CKD progression and with ESRD (p for curves <0.001; Figure).

Conclusion

This study indicates that both high and low ABI are associated with increased risk of CKD progression and ESRD and that even after adjustment for baseline ABI, repeated measures of ABI averaged over time are associated with CKD progression and ESRD. These findings suggest that ABI can be used to facilitate risk stratification for CKD progression.

Funding

  • NIDDK Support