Ungprasert Phuangpaka, Pornratanarangsi Suwatchai
Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2011 Feb;94 Suppl 1:S46-50.
Atherosclerotic disease is the most common disease in clinical practice. Risk factors for the disease include diabetes, hypertension, dyslipidemia, smoking and chronic kidney disease (CKD). However, few studies have reported the correlation between peripheral arterial disease (PAD) and stages of CKD. Ankle brachial index (ABI) is a non-invasive method for detecting PAD with high sensitivity and specificity.
We studied the prevalence of asymptomatic PAD in patients with each stage of CKD using ABI measurement.
We conducted a study of patients with CKD classified by the Kidney Disease Outcomes Quality Initiative classification (K/DOQI classification) who attended at outpatient clinics. The patients with symptomatic PAD will be excluded. The participants will be sent to ABI measurement for the diagnosis of PAD, defined as ABI less than 0.9
The total number of patients who had been enrolled in the study was 201; Male 55%. Mean age was 65.16 +/- 11.3 years. 22.4% of the patients have ABI less than 0.9 which was associated with older age, being female, and having lower diastolic blood pressure (p = 0.002, < 0.001, < 0.0001, respectively) . Diabetes and coronary artery disease were higher in patients with abnormal ABI but with no statistical significance. No difference in other risk factors, for example, hypertension, dyslipidemia and smoking, was detected. Abnormal ABI was frequently seen in the patients with more advanced CKD and mean ABI was lower in patients with more advanced CKD stage. The meanABI of stage 4 and 5 CKD patients was lower than that of stage 1 and 2 (p < 0.05).
The prevalence of asymptomatic PAD increased with more advanced stage of CKD.
动脉粥样硬化疾病是临床实践中最常见的疾病。该疾病的危险因素包括糖尿病、高血压、血脂异常、吸烟和慢性肾脏病(CKD)。然而,很少有研究报道外周动脉疾病(PAD)与CKD分期之间的相关性。踝臂指数(ABI)是一种检测PAD的非侵入性方法,具有高灵敏度和特异性。
我们使用ABI测量研究了CKD各期患者中无症状PAD的患病率。
我们对在门诊就诊的根据肾脏病预后质量倡议分类(K/DOQI分类)分类的CKD患者进行了一项研究。有症状的PAD患者将被排除。参与者将接受ABI测量以诊断PAD,定义为ABI小于0.9。
纳入研究的患者总数为201例;男性占55%。平均年龄为65.16±11.3岁。22.4%的患者ABI小于0.9,这与年龄较大、女性以及舒张压较低有关(分别为p = 0.002、<0.001、<0.0001)。ABI异常的患者中糖尿病和冠状动脉疾病的发生率较高,但无统计学意义。未检测到其他危险因素(如高血压、血脂异常和吸烟)存在差异。在CKD更晚期的患者中经常出现ABI异常,且CKD分期越晚的患者平均ABI越低。4期和5期CKD患者的平均ABI低于1期和2期(p < 0.05)。
无症状PAD的患病率随着CKD分期的增加而升高。