Ankle Brachial Index and Subsequent Cardiovascular Disease Risk in Patients With Chronic Kidney Disease

Background The clinical implications of ankle‐brachial index ( ABI ) cutpoints are not well defined in patients with chronic kidney disease ( CKD ) despite increased prevalence of high ABI attributed to arterial stiffness. We examined the relationship of ABI with cardiovascular disease ( CVD ) and all‐cause mortality among CKD patients. Methods and Results Three thousand six hundred twenty‐seven participants without clinical peripheral artery disease ( PAD ) at baseline from the Chronic Renal Insufficiency Cohort Study were included. ABI was obtained per standard protocol and CVD events were confirmed by medical record adjudication. A U‐shaped association of ABI with PAD , myocardial infarction ( MI ), composite CVD , and all‐cause mortality was observed. Individuals with an ABI between 1.0 and ABI between 1.0 and ABI of PAD ; 1.67 (1.23, 2.29), 1.85 (1.33, 2.57), and 2.08 (1.10, 3.93) for MI ; 1.51 (1.27, 1.79), 1.39 (1.15, 1.68), and 1.23 (0.82, 1.84) for composite CVD ; and 1.55 (1.28, 1.89), 1.36 (1.10, 1.69), and 1.00 (0.62, 1.62) for all‐cause mortality, respectively. Conclusions This study indicates that ABI PAD , MI , composite CVD , and all‐cause mortality whereas ABI ≥1.4 was related to clinical PAD . These findings suggest that ABI cutpoints of PAD and ABI CVD risk stratification should be further evaluated among CKD patients.