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Nutrients 2017, 9(4), 416; doi:10.3390/nu9040416

The Association of Ankle Brachial Index, Protein-Energy Wasting, and Inflammation Status with Cardiovascular Mortality in Patients on Chronic Hemodialysis

1
Department of Cardiology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
2
Department of Nephrology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
3
Department of Nephrology and Renal Replacement Therapy, Nagya University Graduate School of Medicine, Nagoya 466-8550, Japan
4
Cardiovascular Center, Nagoya Kyoritsu Hospital, Nagoya 466-8550, Japan
5
Department of Cardiovascular Surgery, Matsunami General Hospital, Kasamatsu 501-6062, Japan
*
Author to whom correspondence should be addressed.
Received: 27 February 2017 / Revised: 17 April 2017 / Accepted: 18 April 2017 / Published: 21 April 2017
(This article belongs to the Special Issue Nutrition and Chronic Kidney Disease)
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Abstract

Protein-energy wasting (PEW) is highly prevalent in hemodialysis (HD) patients. We investigated the association of abnormal ankle brachial index (ABI), PEW, and chronic inflammation status with clinical prognosis in HD patients. A total of 973 HD patients were enrolled and were followed-up for 8 years. As a marker of the PEW, geriatric nutritional risk index (GNRI) was used. Cut-off levels were 91.2 for GNRI defined from previous studies and 1.9 mg/L for C-reactive protein (CRP) as median value, respectively. Abnormal ABI was seen in 332 (34.1%) patients. Declined GNRI and elevated CRP levels were independently associated with abnormal ABI (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.96–0.99, p = 0.0009 and OR 1.40, 95% CI 1.07–1.83, p = 0.013, respectively). GNRI levels were also independently correlated with CRP levels (β = −0.126, p < 0.0001). During follow-up period, 283 (29.1%) patients died, including 123 (12.6%) due to cardiovascular disease (CVD). Abnormal ABI (adjusted hazard ratio (HR) 1.62, 95% CI 1.13–2.32, p = 0.0096), GNRI < 91.2 (adjusted HR 1.57, 95% CI 1.06–2.33, p = 0.023) and CRP > 1.9 mg/L (adjusted HR 1.89, 95% CI 1.31–2.77, p = 0.0007) independently predicted mortality due to CVD, respectively. In conclusion, abnormal ABI, GNRI, and CRP levels were closely associated with each other, and the combination of these variables increase their predictive values for the risk of mortality due to CVD and all-cause mortality in HD patients. View Full-Text
Keywords: hemodialysis; ankle brachial index; protein energy wasting; geriatric nutritional risk index; inflammation hemodialysis; ankle brachial index; protein energy wasting; geriatric nutritional risk index; inflammation
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MDPI and ACS Style

Ishii, H.; Takahashi, H.; Ito, Y.; Aoyama, T.; Kamoi, D.; Sakakibara, T.; Umemoto, N.; Kumada, Y.; Suzuki, S.; Murohara, T. The Association of Ankle Brachial Index, Protein-Energy Wasting, and Inflammation Status with Cardiovascular Mortality in Patients on Chronic Hemodialysis. Nutrients 2017, 9, 416.

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