Beruflich Dokumente
Kultur Dokumente
97]
Saudi Journal
of Kidney Diseases
and Transplantation
Original Article
Prevalence of Peripheral Arterial Disease Diagnosed by Ankle Brachial
Index among Chronic Kidney Disease Patients in a Tertiary Care Unit
Saeed Laghari, Kifayat Ullah, Imtiaz Masroor, Ghias Butt, Farina Kifayat
Department of Nephrology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
ABSTRACT. The objective of this study is to determine the prevalence of peripheral vascular
disease (PVD) in patients with chronic kidney disease (CKD). Seventy-two patients with CKD
stage 3 or above were included in this study. Blood samples were taken from each patient to
determine complete blood counts, serum albumin, electrolytes, lipid profile and blood sugar
random/fasting. The glomerular filtration rate (GFR) was estimated with the CockcroftGault
formula. The anklebrachial index (ABI) was determined to identify the presence of PVD. A
standardized Doppler ultrasound device was used. ABI of <0.90 was considered diagnostic of
PVD. The mean age of the patients was 53.22 12.8 years. Forty-six patients (63.9%) were male.
Twenty-five patients (34.7%) were in stage 3 CKD, 20 patients (27.8%) were in stage 4 CKD and
27 patients (37.5%) were in stage 5 CKD. Twenty patients (27.8%) had an ABI <0.9 and hence
had PVD. Of these patients, 13 (18.1%) had mild to moderate PVD with ABI of 0.410.90 and
seven (9.7%) had severe PVD with ABI of 0.000.40. All the baseline parameters including
systolic blood pressure (BP), diastolic BP, height, weight, body mass index, GFR, hemoglobin,
total blood count, platelets, triglycerides, high-density lipoprotein, low-density lipoprotein and
uric acid were not significantly different between patients with and without PVD (P >0.05). However, the mean total cholesterol was significantly higher among patients with PVD. The prevalence of PVD was significantly high in patients with stage 5 CKD (P <0.05). PVD is frequent
among patients with CKD based on the ABI as measured by Doppler ultrasound.
Introduction
Chronic kidney disease (CKD) is a major public health problem worldwide and is associated
Correspondence to:
Dr. Kifayat Ullah,
Department of Nephrology,
Pakistan Institute of Medical Sciences,
Islamabad, Pakistan.
E-mail: drkifayat@gmail.com
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ments were made 5 min apart with the participant in the supine position. The ABI was computed by dividing the average of two ankle
systolic BP measurements by the average of
the first two brachial readings. The CKD patients, with or without PAD, were managed
accordingly. All this information was collected
on the proforma.
Data were analyzed using SPSS version 10.
The descriptive analysis were carried out and
reported as mean with standard deviation and
median for continuous variables such as age of
patients. For categorical variables such as gender, causes of CKD such as diabetes, hypertension, pain in legs, smoking history and
presence of PAD, frequencies and percentages were reported. The comparison of relative frequency of PAD among the various
stages of CKD (stage 3 onward) was performed using the Chi-square test and P-values
were reported. Likewise, the comparison of
relative frequency of PAD between male and
female patients with CKD was performed
using the Chi-square test and P-values were
reported. The level of significance was selected
at 5% (P-value <0.05).
Results
A total of 72 CKD patients were included in
Maximum
200
130
167.5
70
33.7
12
9.3
325
280
281
56
99
9
10
4.5
5.5
1.30
Mean
149.5
88.61
158.57
59.09
23.79
8.9458
6.4264
222.23
171.83
140.31
45.16
64.70
5.97
9.04
3.26
4.1
0.91
Std. deviation
24.17
13.563
3.24
5.25
2.623
1.50
1.47
46.19
28.169
49.22
6.61
16.16
1.16
0.39
0.56
0.67
0.27
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Table 2. Baseline characteristics of patients with and without peripheral arterial disease.
Peripheral arterial
No peripheral arterial
disease (N = 20)
disease (N = 52)
Age in years
51.95 14.63
53.71 12.26
Systolic blood pressure
150.75 22.14
149.13 25.10
Diastolic blood pressure
90.50 13.56
87.88 13.62
Height (cm)
158.50 2.61
158.60 3.48
Weight (kg)
59.80 4.38
58.82 5.56
Body mass index
24.46 2.72
23.53 2.56
Glomerular filtration rate (mL/min)
21 16.61
29.4 17.77
Hemoglobin (g/dL)
8.44 1.31
9.13 1.53
Total leukocyte count (109/L)
6.41 1.41
6.43 1.50
9
Platelets (10 /L)
230.20 51.38
219.17 44.19
Cholesterol (mg/dL)
194.62 40.92
163.06 14.09
Triglycerides (mg/dL)
151.6 52.78
135.98 47.59
High-density lipoprotein (mg/dL)
43.85 7.47
45.67 6.25
Low-density lipoprotein (mg/dL)
63.9 16.08
65.01 16.33
Uric acid (mg/dL)
6.06 1.36
5.93 1.09
Calcium (mg/dL)
9.05 0.38
9.03 0.39
Phosphate (mg/dL)
3.35 0.53
3.23 0.57
Albumin (mg/dL)
4.05 0.65
4.11 0.68
P-value
0.607
0.802
0.469
0.902
0.485
0.178
0.072
0.079
0.954
0.368
0.00
0.230
0.298
0.795
0.674
0.897
0.450
0.719
Discussion
Lower extremity PAD has not been evaluated
in most prior epidemiological studies of cardiovascular disease among patients with
CKD,16 and very few studies of PAD have
considered CKD as a potential risk factor.17
Thus, knowledge of the epidemiology, outcomes and treatment options for PAD among
patients with CKD lags behind that for other
forms of cardiovascular disease.
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