Rate of Ankle‐Brachial Index Decline Predicts Cardiovascular Mortality in Hemodialysis Patients

Chronic kidney disease is a risk factor for cardiovascular mortality and morbidity of cardiovascular events ( CVEs ). We obtained baseline data regarding blood biochemistry, ankle‐brachial index ( ABI ), brachial‐ankle pulse wave velocity ( baPWV ) and echocardiographic parameters from 300 patients on hemodialysis in 2005. We also measured ABI and baPWV annually from J une 2005 until J une 2012 and calculated rates of changes in ABI and baPWV to identify factors associated with CVEs . Seventy‐three patients died of cardiovascular disease and 199 CVEs occurred in 164 patients during the study period. Cardiac, cerebrovascular and peripheral artery disease ( PAD ) events occurred in 124, 43 and 32 patients, respectively, and 30 patients had more than two types of CVEs . Analysis using the C ox proportional hazards model showed that a higher rate of decline in ABI (hazard ratio [ HR] , 4.034; P  < 0.001) was the most significant risk factor for decreased patient survival. Multivariate C ox analysis revealed that a higher rate of ABI decline ( HR , 2.342; P  < 0.001) was a significant risk factor for cardiac events, and that a lower baseline ABI was a risk factor for cerebrovascular ( HR , 0.793; P  = 0.03) and PAD ( HR , 0.595; P  < 0.0001) events. Our findings suggested that the rate of a decline in ABI and the baseline ABI value are potent correlation factors for survival and CVE morbidity among patients on hemodialysis in J apan.