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Association of the Cardioankle Vascular Index and Ankle-Brachial Index with Carotid Artery Intima Media Thickness in Hemodialysis Patients

DOI: 10.1155/2013/401525

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The objectives of the present study are (1) to compare the cardioankle vascular index (CAVI), ankle-brachial index (ABI), and carotid artery intima-media thickness (CA-IMT) between HD patients with and without type 2 diabetes (T2D) or prevalence of cardiovascular (CV) disease and (2) also to evaluate the relationship of these indices with CA-IMT in these patients according to ABI levels. This study consisted of 132 HD patients with T2D and the same number of patients without T2D. The patients with diabetes or prevalence of CV disease had significantly higher CA-IMT and lower ABI values than those without diabetes or prevalence of CV disease, respectively. Although diabetic patients had higher CAVI than those without diabetes, CAVI did not differ between patients with or without prevalence of CV disease. In univariate analysis, CA-IMT was more strongly correlated with ABI than CAVI. However, the opposite was true in patients with an ABI value of more than 0.95. Both indices were significantly correlated with CA-IMT although ABI was a powerful determinant than CAVI. It appears that both indices are associated with CA-IMT in HD patients, especially with an ABI value of more than 0.95. 1. Introduction Cardiovascular (CV) diseases are major causes of death in patients with end-stage kidney disease (ESKD), especially for patients with type 2 diabetes (T2D). Carotid artery IMT (CA-IMT) is one of the most established predictors of death from CV disease independent of other classical risk factors in hemodialysis (HD) patients [1–3], although recent studies reported that the association between CA-IMT progression assessed from two ultrasound scans and CV disease remains unproven in general population [4, 5]. The ankle-brachial index (ABI) is used to diagnose peripheral artery occlusive disease (PAOD), and for patients, with an ABI value of less than 0.90, it is accepted as a reliable marker for PAOD [6]. A lower ABI value has also been shown to be significantly associated with CV diseases [7]. On the other hand, brachial-ankle pulse wave velocity (baPWV) is a useful marker for measuring arterial stiffness, one aspect of arteriosclerosis [8]. Several studies have demonstrated that both indices reflect the severity of carotid arteriosclerosis and predict all-cause and CV mortality in HD patients [9–12]. However, one drawback of baPWV is that it is affected by changes in blood pressure during measurements. Recently, a novel arterial stiffness parameter, the cardio-ankle vascular index (CAVI), was developed by measuring baPWV and blood pressure. Unlike baPWV, CAVI is


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