THE SHINSHU MEDICAL JOURNAL
Online ISSN : 1884-6580
Print ISSN : 0037-3826
ISSN-L : 0037-3826
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The Optimal Cut-off Value of Ankle Brachial Index for Screening Cardiovascular Disease Risk in Hemodialysis Patients
Makoto HARADAWataru TSUKADAOsamu TSUKADAKoji HASHIMOTOYuji KAMIJO
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2016 Volume 64 Issue 3 Pages 135-146

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Abstract

Severe atherosclerosis and vascular calcification, causing coronary artery stenosis or peripheral artery diseases (PAD), are frequently detected in hemodialysis (HD) patients. Ankle brachial index (ABI) is a useful marker for detecting PAD, as well as being predictive of the development of cardiovascular diseases (CVD). However, obvious atherosclerotic vascular changes in HD patients might elevate the optimal cut-off value of ABI for screening CVD over the conventional ABI cut-off value, 0.9. Moreover, the ABI cut-off value may be altered by the presence of diabetes mellitus (DM) in HD patients. This retrospective cohort study involved 110 patients on maintenance HD. The ABI cut-off value predicting CVD in HD patients was determined by receiver operating curve (ROC) analysis. ABI cut-off values were also compared in groups of subjects with and without DM. The ABI cut-off value predictive of CVD in all 110 HD patients was 0.960 (area under the curve [AUC] 0.761, sensitivity 0.641, specificity 0.803). The cut-off value of ABI was 1.045 in the DM group (AUC 0.735, sensitivity 0.813, specificity 0.606) and 0.960 in the non-DM group (AUC 0.773, sensitivity 0.714, specificity 0.868). Kaplan-Meier analysis showed that patients with ABI below the cut-off values in each group were significantly more likely to develop CVD. The optimal ABI cut-off values for screening high-risk HD patients with CVD should be set at higher levels than the conventional cut-off value (0.9), and that the optimal cut-off values might differ in HD patients with and without DM, at 1.045 and 0.960, respectively.

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© 2016 Shinshu Medical Society
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