Reliability of ankle-brachial index in the detection of clinically significant peripheral arterial occlusive disease of lower extremities in kidney patients on hemodialysis

Periferna arterijska okluzivna bolest (PAOB) je učestala kod pacijenata u završnom stadijumu bubrežne bolesti na hemodijalizi, ali je često nedovoljno dijagnostikovana. Faktori rizika za PAOB (starost, dijabetes mellitus, pušenje, hiperlipidemija i hipertenzija) su dobro poznati u opštoj populaciji, ali su nešto različiti kod pacijenata na hemodijalizi. Primarni i osnovni test za dijagnostikovanje PAOB su pedo-brahijalni indeksi (PBI) sa vrednošću < 0.9 koja važi za opštu populaciju sa visokom senzitivnošću i specifičnosti testa. Zbog izraženih kalcifikacija i krutosti krvnih sudova kod pacijenata na hemodijalizi, rezultati PBI često su lažno povišeni a senzitivnost testa je značajno niža. Zbog toga smo ispitivali prevalencu PAOB, faktore rizika kao i pouzdanost PBI u dijagnostikovanju PAOB kod pacijenata na hemodijalizi u poreĎenju sa CT angiografijom kao zlatnim standardom. Metode: Radili smo studiju preseka kako bi ispitali prevalencu PAOB, faktore rizika i kliničke karakteristike meĎu 156 pacijenata na hemodijalizi. Analizirali smo komorbiditet i laboratorijske parametre. Nakon kliničkog pregleda sa palpacijom pulseva i auskultacijom femoralnog šuma, mereni su PBI kod svih pacijenata. PAOB je dijagnostikovana na osnovu kliničkih nalaza, vrednosti PBI < 0.9 i simptoma PAOB. Izračunavali smo PBI na tri načina kao PBI min, PBI max i PBI prosek i odreĎivali senzitivnost, specifičnost i ukupnu tačnost testa u odnosu na CT angiografski nalaz kao zlatni standard. Od statističkih analiza koristili smo deskriptivne statističke metode, Studentov t-test, Mann-Vhitney U test, Pearsonov hi-kvadrat test, Fisher-ov test i multivarijantni logistički regresioni model. Rezultati: PAOB je bila prisutna kod 55 od 156 (35.3%) pacijenata. Pacijenti sa PAOB bili su značajno stariji (67 ± 11 naspram 63 ± 11 godina, p = 0.014) u odnosu na pacijente bez PAOB, imali su češće dijabetes mellitus 38.2% (p = 0.022) i anemiju 98% (p = 0.042)...Peripheral arterial disease (PAD) is common in end-stage renal disease patients on hemodialysis, but is frequently under-diagnosed. The risk factors for PAD (age, diabetes mellitus, smoking, hyperlipidemia, and hypertension) are well known in the general population but are somewhat different in patients on hemodialysis. The primary diagnostic test for the diagnosis of PAD is ankle-brachial index (ABI) with a value < 0.9 valid in the general population with high sensitivity and specificity of the test. Due to the pronounced calcifications and stiffness of the blood vessels in patients on hemodialysis, ABI results were often falsely elevated and the sensitivity of the test was significantly lower. Therefore, we examined the prevalence of PAD and risk factors in patients on hemodialysis, and the reliability of ABI in the diagnosis of PAD compared to CT angiography as a golden standard. Methods: We performed a cross-sectional study to examine the prevalence of PAD, risk factors and clinical characteristics among 156 patients on hemodialysis. We analyzed comorbidity and laboratory parameters. Following clinical examination with pulse palpation and femoral bruit auscultation, the ABI was measured in all patients. PAD was diagnosed based on clinical findings, ABI values < 0.9, and PAD symptoms. We calculated ABI in three ways as ABI low, ABI high, and ABI mean, and determined sensitivity, specificity and overall test accuracy compared to CT angiography as the golden standard. Of statistical analysis we used descriptive statistics, Student’s t-test, Mann-Whitney U test, Pearson’s chi-square test, Fisher’s exact test, and multivariate logistic regression model. Results: PAD was present in 55/156 (35.3%) patients. The PAD patients were significantly older (67 ± 11 vs. 63 ± 11 years, p = 0.014) than the non-PAD group, and had more frequently diabetes mellitus 38.2% (p = 0.022), and anemia 98% (p = 0.042). PAD patients had significantly lower serum albumin levels (p = 0.005), total cholesterol (p = 0.024), iron (p = 0.004), Kt/V (p = 0.04), higher glucose levels (p = 0.002), and higher C-reactive protein (p = 0.0004), than non-PAD patients..