MP410A DECREASE OF THE ANKLE-BRACHIAL PRESSURE INDEX (ABI) IS THE IMPORTANT RISK FACTORS FOR MORTALITY IN LONG-TERM DIALYSIS PATIENTS

Abstract

Introduction and Aims: In Japan, hemodialysis patients are advancing in age, and the average duration of dialysis is getting longer, a situation that might also be occurring in other countries, and early detection of risks to longevity is important. The ankle-brachial pressure index (ABI) is known as an independent predictor of mortality. In this study, we investigated the factors that might predict adverse change of the ABI in patients on long-term dialysis. Methods: A total of 61 patients on maintenance hemodialysis who received ABI examinations in both 2005 and 2011 were enrolled in this study. The changes of the ABI from 2005 to 2011 were evaluated, along with analysis of the patient outcomes. Furthermore, the relationships between the changes of the ABI and several clinical factors estimated in 2005 were also examined. Clinical data including age, sex, durations of hemodialysis therapy, presence of diabetes mellitus and/or hypertension complications and biological examinations, were collected from the patient's records. Results: The mean follow-up period was 3.1 ± 0.7 years. Univariate analysis using a Cox proportional hazards model identified low ABI (right HR, 0.51 [0.33-0.75]; left HR, 0.55 [0.38-0.79]; [ per 0.1 increase]), and a reduction of the ABI (right HR, 0.75 [0.60-1.00]; left HR, 0.53 [0.37-0.75]; [per 0.1 increase]) as predictors of mortality. Changes of the ABI were correlated with the age of the patients (P = 0.030) and correlated with the serum creatinine level (P = 0.022). We confirmed that a decrease of the ABI is one of the important risk factors for mortality in hemodialysis patients. Changes of the ABI were inversely correlated with the age and correlated with the serum creatinine level. Decrease of the ABI is caused by the failure of the lower limb blood flow. Low muscle mass is caused by the symptom of impaired blood circulation. Muscle mass is an important predictor of mortality risk, it is very important to detect a decrease in ABI. ABI test is a non-invasive examination. Additionally it is less affected by dialysis dose, vascular access recirculation and diet compared to blood test. Therefore, it is important to follow up patients not only by routine blood tests but also by routine ABI tests. Conclusions: Careful observation of the ABI may be needed in elderly patients and patients with a relatively low muscle mass.