Key result
Diabetes linked to ~0.02 greater annual ABI decline in hemodialysis patients.
Why the study?
Peripheral artery occlusive disease progresses faster and leads to worse outcomes in diabetes mellitus and end-stage renal disease patients, but longitudinal data on ABI decline in hemodialysis patients are lacking.
Cohort (n=296)
No
Mean Difference: -0.024 (95% CI -0.036–-0.012)
Absolute Event Rate: -0.014% vs 0.01%
p-value: p=<0.001
DM associated with faster ABI decline in HD patients; leaves open whether targeted surveillance alters limb outcomes.
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.
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Chen et al. (2017) conducted a cohort in End-stage renal disease on hemodialysis (n=296). Diabetes mellitus vs. Non-diabetes mellitus was evaluated on Annual change in ankle-brachial index (ABI) (MD -0.024, 95% CI -0.036 to -0.012, p=<0.001). Diabetes mellitus in hemodialysis patients was associated with a significantly more rapid annual decline in ankle-brachial index compared to non-diabetic patients (MD -0.024).
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