Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Hemodial Int. 2020 Jul;24(3):335-343. doi: 10.1111/hdi.12835. Epub 2020 May 14.
An abnormal ankle-brachial index indicating presence of peripheral arterial disease (PAD) is known to predict mortality in end-stage renal disease (ESRD). Hand ischemia, reflected by low finger pressures, is also a factor associated with increased mortality in patients undergoing hemodialysis (HD). The Aim of the present study is to determine whether an abnormal digital brachial index in ESRD patients prior to HD access surgery is related to lower survival rates.
A digital brachial index (DBI, systolic finger pressure/systolic brachial arterial pressure) was obtained using digital plethysmography in ESRD patients before construction of a primary HD access between January 2009 and December 2018 in a single center. Patients were grouped based on categories of DBI (low <80%, normal 80-99%, high ≥100%). Overall and cardiovascular mortality were assessed with the ERA-EDTA classification system (ERA-EDTA codes 11, 14-16, 18, and 22-26, 29). Factors potentially influencing survival rates were analyzed using standard statistics.
Follow-up was available in 199 patients (female n = 80; age 70 years ±12; follow-up index 99% ±1). Overall, 2 and 4 years survival were similar among DBI groups Moreover, 2 and 4 years freedom from cardiovascular death were also not different (low DBI 80% ±8 and 58% ±11; normal DBI 86% ±4 and 75% ±6; high DBI 74% ±6 and 61% ±7). Following correction for age, diabetes mellitus, cardiovascular disease and smoking, a high DBI conferred a significantly increased risk of cardiovascular mortality (HR 2.09 [1.06-4.13], P = 0.03) and a trend toward higher overall mortality (HR 1.69 [0.98-2.93], P = 0.06).
ESRD patients with an abnormally elevated DBI before HD access creation have an increased risk of cardiovascular mortality in the first four postoperative years.
踝臂指数异常表明存在外周动脉疾病（PAD），已知其可预测终末期肾病（ESRD）患者的死亡率。手指压低反映的手部缺血也是血液透析（HD）患者死亡率增加的一个因素。本研究旨在确定 ESRD 患者在进行 HD 通路手术前的数字肱动脉指数（DBI，收缩压/肱动脉收缩压）异常是否与较低的生存率相关。
在 2009 年 1 月至 2018 年 12 月期间，在一家中心，使用数字容积描记法在接受 HD 通路手术前的 ESRD 患者中获得数字肱动脉指数（DBI，收缩压/肱动脉收缩压）。根据 DBI 类别（低 <80%，正常 80-99%，高 ≥100%）对患者进行分组。使用 ERA-EDTA 分类系统（ERA-EDTA 代码 11、14-16、18、22-26、29）评估总死亡率和心血管死亡率。使用标准统计学方法分析影响生存率的潜在因素。
199 名患者（女性 n = 80；年龄 70 岁 ±12 岁；随访指数 99% ±1）的随访数据可用。总体而言，DBI 组的 2 年和 4 年生存率相似。此外，2 年和 4 年免于心血管死亡的情况也无差异（低 DBI 为 80% ±8 和 58% ±11；正常 DBI 为 86% ±4 和 75% ±6；高 DBI 为 74% ±6 和 61% ±7）。在校正年龄、糖尿病、心血管疾病和吸烟后，高 DBI 显著增加了心血管死亡率的风险（HR 2.09[1.06-4.13]，P = 0.03），且整体死亡率呈上升趋势（HR 1.69[0.98-2.93]，P = 0.06）。
在进行 HD 通路创建之前，DBI 异常升高的 ESRD 患者在术后头四年发生心血管死亡的风险增加。
