Key result
An abnormal ankle-brachial index in hemodialysis patients was associated with a three-fold higher risk of a reverse dipping blood pressure pattern during the second interdialytic day (OR 3.2).
Why the study?
Is abnormal ankle-brachial index associated with changes in interdialytic ambulatory blood pressure monitoring patterns in hemodialysis patients?
Cross-Sectional (n=81)
No
Is abnormal ankle-brachial index associated with changes in interdialytic ambulatory blood pressure monitoring patterns in hemodialysis patients?
Odds Ratio: 3.2 (95% CI 1.1–9.57)
p-value: p=0.03
In hemodialysis patients, an abnormal ankle-brachial index is associated with an altered interdialytic blood pressure pattern, specifically a higher systolic BP night/day ratio on the second day.
Abnormal ABI links to altered interdialytic BP patterns in HD; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: Patients undergoing chronic hemodialysis (HD) are at increased risk for peripheral artery disease (PAD). Both ankle-brachial index (ABI) and ambulatory blood pressure monitoring (ABPM) in the interdialytic period have been shown to be strong predictors of all-cause mortality. METHODS: This cross-sectional study investigated the relationship between ABPM profile and ABI in 81 HD patients. ABPM was measured throughout a 44-h midweek interdialytic period. Pre-dialysis ABI was evaluated with a BOSO ABI device. An ABI value <0.9 or ≥1.3 was defined as abnormal. RESULTS: In the whole study group (72 % males, mean age 67 ± 14 years), there was an increase in BP (p < 0.05) and in systolic BP night/day ratio (n/dSR, p = 0.01) during the interdialytic period. Patients with abnormal ABI (n = 29) more frequently had a positive history for cerebrovascular accident and PAD and higher proBNP values than those with normal ABI (n = 52). No difference was detected among ABPM-derived components except for the n/dSR (p = 0.02). Patients with abnormal ABI showed a significantly increased n/dSR (p = 0.02) and ambulatory arterial stiffness index (AASI) (p = 0.006) on the second day compared to the first. Patients with n/dSR >1 during day 2 (n = 34) were older, showed significantly higher proBNP and AASI and were more likely to reveal abnormal ABI compared to those with a lower n/dSR (p = 0.006). CONCLUSIONS: Abnormal ABI in HD patients is associated to changes in interdialytic ABPM pattern, namely higher n/dSR on day 2. These data may indicate the pathophysiological mechanisms underlying the worse outcome observed in HD patients.
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Viazzi et al. (2016) conducted a cross-sectional in End-stage renal disease on hemodialysis (n=81). Abnormal ankle-brachial index (ABI <0.9 or >=1.3) vs. Normal ankle-brachial index was evaluated on Risk of being a riser (night/day systolic ratio > 1) in the second interdialytic day (OR 3.2, 95% CI 1.10-9.57, p=0.03). An abnormal ankle-brachial index in hemodialysis patients was associated with a three-fold higher risk of a reverse dipping blood pressure pattern during the second interdialytic day (OR 3.2).
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