Association of diabetes mellitus with decline in ankle-brachial index among patients on hemodialysis: A 6-year follow-up study

PLoS One. 2017 Apr 13;12(4):e0175363. doi: 10.1371/journal.pone.0175363. eCollection 2017.

Abstract

Peripheral artery occlusive disease is common among diabetes mellitus (DM) and end-stage renal disease patients, and tends to progress faster and lead to worse outcomes. This study compared the association of DM with the decline in ankle-brachial index (ABI) among patients on hemodialysis (HD). This was a longitudinal analysis of ABI in HD patients from 2009 to 2015. Medical records and yearly ABI values were obtained. A longitudinal mixed-model analysis was used to evaluate ABI changing trends while accounting for within-patients correlation. There were 296 patients on HD in the period of 2009-2015. In a 6-year follow-up, those with DM had a more rapid ABI decline compared to non-DM patients (slopes: -0.014 vs. 0.010 per year, interaction p < 0.001). In DM patients, female sex, high pulse pressure, high triglyceride, low creatinine, and high uric acid were associated with a decrease in ABI. In non-DM patients, old age, high pulse pressure, high low-density lipoprotein cholesterol, and high uric acid were associated with a decreased in ABI. There were 49.6% of patients with a normal ABI experienced a decrease at least 0.1 of ABI from baseline, and 35.3% had a final ABI < 0.9 in patients with a baseline ABI ≥ 0.9 (n = 232). In this study, DM patients on HD tend to develop a more rapid decline in ABI than non-DM patients on HD. Age, sex, pulse pressure, lipid profile, creatinine, and uric acid are associated with a decreased in ABI.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Ankle Brachial Index*
  • Blood Pressure
  • Creatinine / blood
  • Diabetes Mellitus* / blood
  • Diabetes Mellitus* / physiopathology
  • Diabetes Mellitus* / therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Models, Biological*
  • Peripheral Arterial Disease* / blood
  • Peripheral Arterial Disease* / physiopathology
  • Peripheral Arterial Disease* / therapy
  • Renal Dialysis*
  • Sex Factors
  • Taiwan
  • Triglycerides / blood
  • Uric Acid / blood

Substances

  • Triglycerides
  • Uric Acid
  • Creatinine

Grants and funding

The research presented in this article is supported by the grants from Kaohsiung Municipal Hsiao-Kang Hospital (kmhk-105-002), Kaohsiung Medical University, Kaohsiung, Taiwan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.