Different Ankle Brachial Index Levels in Asymptomatic Hemodialysis Patients

Background. It has been suggested that a resting ankle brachial systolic pressure index (ABI) level of ≤ 0.90 is 95% sensitive in detecting an angiogram-positive peripheral arterial disease (PAD) and that falsely elevated pressures or incompressible arteries at the ankle level and ABI ≥ 1.30 might be caused by mediosclerosis. Methods. In a cross-sectional study on 117 asymptomatic hemodialysis (HD) patients, we evaluated the presence of PAD and mediosclerosis assessed by ABI measurement, and the presence of atherosclerotic lesions in patients with different ABI levels on high resolution B-mode ultrasonography (US) of the common carotid (CCA) and femoral arteries (FA). Finally, we compared various groups of patients according to the ABI levels for a number of clinical and biochemical parameters which might be responsible for those conditions. Results. Our results showed frequent presence of high ABI (33.3%) and low ABI (23.1%) levels in asymptomatic HD patients. The low ABI group of patients were older, presented with more diabetics, lower dialysis adequacy, a higher dose of prescribed calcium carbonate and a number of documented cardiovascular and peripheral arterial diseases, as well as an increased CCA intima media thickness and a higher frequency of atherosclerotic and calcified intimal plaques. The high ABI group characterised by the prevalence of male gender and an increased level of all blood pressure parameters. In addition, patients with high ABI presented with higher internal diameter on CCA and FA. Conclusions. Arterial disease in asymptomatic HD patients is a frequent finding. Screening for atherosclerotic lesions in HD patients could be recommended even if they are symptom free. The participation of a small number of patients in this study needs further confirmation in additional large scale trials.