Association of diabetes mellitus with decline in ankle-brachial index among patients on hemodialysis: A 6-year follow-up study

• Published in: PloS one 2017-04, Vol.12 (4), p.e0175363-e0175363
• Main Authors: Chen, Szu-Chia, Lee, Mei-Yueh, Huang, Jiun-Chi, Mai, Hsiu-Chin, Kuo, Po-Lin, Chang, Jer-Ming, Chen, Hung-Chun, Yang, Yi-Hsin
• Format: Article
• Language: English
• Subjects: Adult; Aged; Amputation; Ankle Brachial Index; Autoimmune diseases; Biology and Life Sciences; Blood Pressure; Care and treatment; Cholesterol; Chronic kidney failure; Clinical medicine; Comparative analysis; Complications and side effects; Creatinine; Creatinine - blood; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - physiopathology; Diabetes Mellitus - therapy; Epidemiology; Female; Follow-Up Studies; Free radicals; Health aspects; Heart; Hemodialysis; Hospitalization; Hospitals; Humans; Immunology; Internal medicine; Kidney diseases; Lipids; Male; Medical records; Medicine; Medicine and Health Sciences; Metabolism; Middle Aged; Models, Biological; Mortality; Nephrology; Patients; Peripheral Arterial Disease - blood; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - therapy; Physical Sciences; Renal Dialysis; Risk factors; Sex; Sex Factors; Statins; Taiwan; Triglycerides; Triglycerides - blood; Uric acid; Uric Acid - blood
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0175363

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.