Key result
Low toe-brachial index with normal ankle-brachial index is linked to diabetes and excess interdialytic weight gain.
Why the study?
The prevalence of peripheral arterial occlusive disease is high in dialysis patients, but risk factors for normal ABI combined with low TBI remain unclear.
What are the risk factors for having a normal ankle-brachial index but a low toe-brachial index in hemodialysis patients?
Observational (n=115)
What are the risk factors for having a normal ankle-brachial index but a low toe-brachial index in hemodialysis patients?
Diabetes and excess interdialytic body weight gain are significant risk factors for peripheral arterial stenotic lesions below the ankle in hemodialysis patients with normal ankle-brachial indices.
May warrant TBI assessment in diabetic HD patients with normal ABI; leaves open whether screening improves outcomes.
The prevalence of peripheral arterial occlusive disease is high in patients with terminal renal failure, and it is a major problem in those on dialysis. A low ankle-brachial index (ABI) suggests the presence of arterial stenotic lesions between the aorta and the ankle joint, while a low toe-brachial index (TBI) suggests stenotic lesions between the aorta and the toes. Therefore, a normal ABI (> or =0.9) and a low TBI (<0.6) may indicate the presence of stenotic lesions located only on the peripheral side of the ankle joint. In the present study, risk factors of normal ABI/low TBI were investigated. In 115 patients on maintenance dialysis, the ABI and TBI were simultaneously measured, and the background factors and laboratory data of patients with normal ABI/low TBI (L group) and those with normal ABI/normal TBI (> or =0.6) (N group) were compared. Low ankle-brachial and toe-brachial indices were detected in 13% and 22% of the patients, respectively. Comparison of the background factors and laboratory data between the N and L groups showed that the ratio of diabetes mellitus, interdialytic body weight gain, and Hb(A1c) values were significantly higher in the L group than in the N group. It was clarified that diabetes and excess body weight gain are involved as risk factors in dialysis patients with normal ABI/low TBI.
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Morimoto et al. (2009) conducted an observational in Terminal renal failure on hemodialysis (n=115). Normal ABI (>=0.9) and low TBI (<0.6) vs. Normal ABI and normal TBI (>=0.6) was evaluated on Differences in background factors and laboratory data including diabetes mellitus, interdialytic body weight gain, and HbA1c. In hemodialysis patients, having a normal ankle-brachial index but a low toe-brachial index was significantly associated with diabetes mellitus and excess interdialytic body weight gain.
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