Author + information
- Tamon Kato1,
- Yusuke Miyashita2,
- Takashi Miura3,
- Souitirou Ebisawa4,
- Tatsuya Saigusa5 and
- Koichiro Kuwahara1
End-stage renal disease (ESRD) patients on hemodialysis (HD) due to diabetic nephropathy increase in the world. And HD patients have severe morbidity and mortality. Especially critical limb ischemia(CLI) is one of the cause of major amputation or death. On the other hand abnormal ankle-brachial index (ABI) has been found to be a strong predictor of mortality for HD patients.
In the (Prospective REgistry with the DIalysis patient due to diabetes to prevent the CriTical limb ischemia) PREDICT study, a multicenter prospective observational study, we enrolled173 consecutive patients on HD due to diabetic nephropathy between April 2012 and August 2013 from 13 institutions. We investigated, performance status, ABI, lower limb artery lesions by duplex ultra sound, at every 6 months for 2 years. Limb artery stenosis defined as peak systolic velocity ratios PSV > 200m/s.
The2-year survival rate was 85.1%. The occurrence of de novo lower limb arteries was 7.6%, and freedom from CLI was 91.5%. However, there was no change in term of ABI between at baseline and 2 year (1.09±0.21, 1.07±0.32). And low ABI patients’ mortality was higher than normal ABI patients’ (38.5% vs. 12.9%, p= 0.027). low ABI patients’ occurrence of CLI was higher than normal ABI patients’ too (25% vs. 4.3%, p<0.001). Cox regression was used to evaluate the association between baseline ABI and mortality, CLI. The low ABI was strong predictor for all cause death and Occurrence CLI (HR2.96; 95%CI, 1.16-7.41 and HR5.65;95%CI,1.69-20.3). The duration of HD was not associate any adverse events.
This study revealed high mortality, and high incidence rate of stroke, CLI in HD patients with diabetic nephropathy. ABI is useful for the prediction of mortality or adverse events for HD patients.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention