Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China.
Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou City, China.
Ren Fail. 2023 Dec;45(1):2160347. doi: 10.1080/0886022X.2022.2160347.
The effect of a low ankle-brachial index (ABI) in patients with advanced-stage diabetic kidney disease is not fully understood. This study investigates the prevalence of a low ABI in patients with advanced-stage diabetic kidney disease, which was defined as a urinary albumin-to-creatinine ratio (UACR) ≥300 mg/g and an estimated glomerular filtration rate (eGFR) between 15-60 mL/min/1.73 m. Furthermore, the association between a low ABI and end-stage kidney disease (ESKD) was determined.
This single-center, retrospective, cohort study included 529 patients with advanced-stage diabetic kidney disease who were stratified into groups according to the ABI: high (>1.3), normal (0.9-1.3), and low (<0.9). The Kaplan-Meier method and Cox proportional analysis were used to examine the association between the ABI and ESKD.
A total of 42.5% of patients with a low ABI progressed to ESKD. A low ABI was associated with a greater risk of ESKD (hazard ratio (HR): 1.073). After adjusting for traditional chronic kidney disease risk factors, a low ABI remained associated with a greater risk of ESKD (HR: 1.758; 95% confidence interval: 1.243-2.487; = 0.001).
These results indicate that patients with a low ABI should be monitored carefully. Furthermore, preventive therapy should be considered to improve the long-term kidney survival of patients with residual kidney function.
低踝臂指数（ABI）对晚期糖尿病肾病患者的影响尚未完全阐明。本研究旨在探讨晚期糖尿病肾病患者低 ABI 的发生率，晚期糖尿病肾病定义为尿白蛋白与肌酐比值（UACR）≥300mg/g 且估算肾小球滤过率（eGFR）在 15-60ml/min/1.73m 之间。此外，还确定了低 ABI 与终末期肾病（ESKD）之间的关系。
这是一项单中心、回顾性队列研究，共纳入 529 例晚期糖尿病肾病患者，根据 ABI 分为高（>1.3）、正常（0.9-1.3）和低（<0.9）三组。采用 Kaplan-Meier 法和 Cox 比例风险分析评估 ABI 与 ESKD 之间的关系。
共有 42.5%的低 ABI 患者进展为 ESKD。低 ABI 与 ESKD 风险增加相关（风险比（HR）：1.073）。调整传统慢性肾脏病危险因素后，低 ABI 与 ESKD 风险增加仍相关（HR：1.758；95%置信区间：1.243-2.487； = 0.001）。
这些结果表明，低 ABI 患者应密切监测。此外，应考虑预防性治疗以改善有残余肾功能患者的长期肾脏生存。
