Association of Chronic Kidney Disease With the Spectrum of Ankle Brachial Index: The CHS (Cardiovascular Health Study)

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• 作者：Joachim H. Ix ; Ronit Katz ; Ian H. De Boer ; Brian R. Kestenbaum ; Matthew A. Allison ; David S. Siscovick ; Anne B. Newman ; Mark J. Sarnak ; Michael G. Shlipak ; Michael H. Criqui
• 关键词：kidney disease ; chronic ; atherosclerosis ; calcium ; cardiovascular disease ; arterial stiffness
• 刊名：Journal of the American College of Cardiology
• 出版年：2009
• 出版时间：22 September 2009
• 年：2009
• 卷：54
• 期：13
• 页码：1176-1184
• 全文大小：426 K

文摘

Objectives

This study sought to determine the association of chronic kidney disease (CKD) with high ankle brachial index (ABI) measurement and to compare its strength with that of CKD with a low ABI.

Background

CKD is an important risk factor for cardiovascular disease (CVD) events. A high ABI, a marker of lower extremity arterial stiffness, is associated with CVD events and mortality. The association between CKD and high ABI is unknown.

Methods

The CHS (Cardiovascular Health Study) enrolled community-living people >65 years of age and measured kidney function and ABI. Glomerular filtration rate (GFR) was estimated using equations that incorporated either cystatin C or creatinine, and CKD was defined by estimated GFR <60 ml/min/1.73 m². The ABI was categorized as low (<0.90), low-normal (0.90 to 1.09), normal (1.10 to 1.40), and high (>1.40 or incompressible). Multinomial logistic regression was used to evaluate the associations of CKD with ABI categories.

Results

Among 4,513 participants, 23 % had CKD, 13 % had a low ABI, and 3 % had a high ABI. In models adjusted for age, sex, race, hypertension, diabetes, smoking, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and C-reactive protein, cystatin C-based CKD was associated with both low ABI (relative risk [RR]: 2.0; 95 % confidence interval [CI]: 1.6 to 2.5; p <0.001) and high ABI (RR: 1.6; 95 % CI: 1.0 to 2.3; p = 0.03). Results were similar when CKD was defined by creatinine.

Conclusions

CKD is associated with both the high and the low extremes of ABI in community-living older people. Future studies should evaluate whether arterial stiffness is an important mechanism leading to CVD in people with CKD.