Display Settings:

Format

Send to:

Choose Destination
Am J Kidney Dis. 2013 Feb;61(2):204-10. doi: 10.1053/j.ajkd.2012.07.009. Epub 2012 Aug 15.

Low ankle-brachial index and the development of rapid estimated GFR decline and CKD.

Author information

  • 1National Heart, Lung, and Blood Institute's (NHLBI's) Framingham Heart Study, Framingham, MA, USA.

Abstract

BACKGROUND:

Low ankle-brachial index (ABI) is associated with increases in serum creatinine level. Whether low ABI is associated with the development of rapid estimated glomerular filtration rate (eGFR) decline, stage 3 chronic kidney disease (CKD), or microalbuminuria is uncertain.

STUDY DESIGN:

Prospective cohort study.

SETTING & PARTICIPANTS:

Framingham Offspring cohort participants who attended the sixth (1995-1998) and eighth (2005-2008) examinations.

PREDICTOR:

ABI, categorized as normal (>1.1 to <1.4), low-normal (>0.9 to 1.1), and low (≤0.9).

OUTCOMES:

Rapid eGFR decline (eGFR decline ≥3 mL/min/1.73 m(2) per year), incident stage 3 CKD (eGFR <60 mL/min/1.73 m(2)), incident microalbuminuria.

MEASUREMENTS:

GFR was estimated using the serum creatinine-based CKD-EPI (CKD Epidemiology Collaboration) equation. Urinary albumin-creatinine ratio (UACR) was determined based on spot urine samples.

RESULTS:

During 9.5 years, 9.0% (232 of 2,592) experienced rapid eGFR decline and 11.1% (270 of 2,426) developed stage 3 CKD. Compared to normal ABI, low ABI was associated with 5.73-fold increased odds of rapid eGFR decline (95% CI, 2.77-11.85; P<0.001) after age, sex, and baseline eGFR adjustment; this persisted after multivariable adjustment for standard CKD risk factors (OR, 3.60; 95% CI, 1.65-7.87; P = 0.001). After adjustment for age, sex, and baseline eGFR, low ABI was associated with a 2.51-fold increased odds of stage 3 CKD (OR, 2.51; 95% CI, 1.16-5.44; P = 0.02), although this was attenuated after multivariable adjustment (OR, 1.68; 95% CI, 0.75-3.76; P = 0.2). In 1,902 free of baseline microalbuminuria, low ABI was associated with increased odds of microalbuminuria after adjustment for age, sex, and baseline UACR (OR, 2.81; 95% CI, 1.07-7.37; P = 0.04), with attenuation upon further adjustment (OR, 1.88; P = 0.1).

LIMITATIONS:

Limited number of events with low ABI. Outcomes based on single serum creatinine and UACR measurements at each examination.

CONCLUSIONS:

Low ABI is associated with an increased risk of rapid eGFR decline, suggesting that systemic atherosclerosis predicts a decrease in kidney function.

Published by Elsevier Inc.

PMID:
22901770
[PubMed - indexed for MEDLINE]
PMCID:
PMC3517695
Free PMC Article

Images from this publication.See all images (1)Free text

Figure 1
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Write to the Help Desk