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Clin J Am Soc Nephrol. 2012 Oct;7(10):1646-53. doi: 10.2215/CJN.04570512. Epub 2012 Aug 2.

Association of interleg BP difference with overall and cardiovascular mortality in hemodialysis.

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  • 1Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Abstract

BACKGROUND AND OBJECTIVES:

An interarm BP difference has been associated with atherosclerosis and adverse cardiovascular outcomes. This study investigated whether an interleg BP difference was associated with peripheral vascular disease and overall and cardiovascular mortality in hemodialysis patients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

This study enrolled 210 hemodialysis patients from December 2006 to January 2007. Bilateral leg BPs were measured simultaneously by an ankle-brachial index (ABI)-form device before hemodialysis.

RESULTS:

The mean follow-up period was 4.4±1.5 years. ABI <0.9 and high brachial-ankle pulse wave velocity were independently associated with an interleg difference in systolic BP of ≥15 mmHg or diastolic BP of ≥10 mmHg. Furthermore, this difference was an independent predictor for overall mortality (hazard ratio [HR], 3.36; 95% confidence interval [CI], 1.68-6.72; P<0.01) and cardiovascular mortality (HR, 4.84; 95% CI, 1.84-12.71; P<0.01) after adjustment for demographic, clinical, and biochemical parameters. After further adjustment for ABI <0.9 and brachial-ankle pulse wave velocity, the relation remained significant to overall mortality (HR, 2.91; 95% CI, 1.28-6.64; P=0.01) and cardiovascular mortality (HR, 3.15; 95% CI, 1.05-9.44; P=0.04).

CONCLUSIONS:

A difference in systolic BP of ≥15 mmHg or diastolic BP of ≥10 mmHg between legs was associated with peripheral vascular disease and increased risk for overall and cardiovascular mortality in hemodialysis patients. Detection of an interleg BP difference may identify hemodialysis patients at increased risk of peripheral vascular disease and overall and cardiovascular mortality.

PMID:
22859748
[PubMed - indexed for MEDLINE]
PMCID:
PMC3463210
Free PMC Article

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