1
|
Maloberti A, Fribbi F, Motto E, Vallerio P, Occhi L, Palazzini M, Peretti A, Ferraro G, Agrati A, Colombo F, Giannattasio C. Ankle-Brachial Index Is a Predictor of In-Hospital Functional Status but Not of Complications in Hospitalized Elderly Patients. Gerontology 2021; 67:674-680. [PMID: 33756483 DOI: 10.1159/000514450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Atherosclerosis causes a chronic reduction of vascularization with consequent impairment of the performance of organs, like the brain or muscles, which determines the functional and cognitive decline of the elderly and their ability to respond to acute stressful condition. Therefore, our aim was to evaluate if ankle brachial index (ABI) could effectively be a determinant of in-hospital functional status and complications in elderly hospitalized patients. METHODS This is a monocentric cross-sectional study of 189 patients aged 65 years or older. The study was undertaken at the Internal Medicine ward of Niguarda Hospital in Milan. ABI (BOSO ABY-System 100) and in-hospital status (activities of daily living, ADL and instrumental activities of daily living, IADL) were collected on the second day of hospitalization. Complications (falls and delirium episodes) were also recorded during the whole hospitalization period. RESULTS The average age of patients was 79.3 ± 6.9 years. Among outcomes, only ADL (r = 0.192, p = 0.007) and IADL score (r = 0.200, p = 0.005) showed significant correlation with ABI. Moreover, during the subsequent logistic regression, ABI remained among the statistically significant determinants of both scores (β = 0.231, p = 0.013 and β = 0.314, p = 0.001, respectively). CONCLUSIONS The main result of our study is the finding of ABI as a significant determinant of acute in-hospital functional impairment (evaluated as ADL and IADL scores). The continuous exposure of the brain and muscles to the reduced perfusions induced by vascular atherosclerosis, probably determined the reduced ability to respond to stressful conditions.
Collapse
Affiliation(s)
- Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy, .,Cardiology 4, ASST GOM Niguarda Ca Granda Hospital, Milan, Italy,
| | - Francesco Fribbi
- School of Medicine and Surgery, Milano-Statale University, Milan, Italy
| | - Elena Motto
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Paola Vallerio
- Cardiology 4, ASST GOM Niguarda Ca Granda Hospital, Milan, Italy
| | - Lucia Occhi
- Cardiology 4, ASST GOM Niguarda Ca Granda Hospital, Milan, Italy
| | - Matteo Palazzini
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.,Cardiology 4, ASST GOM Niguarda Ca Granda Hospital, Milan, Italy
| | - Alessio Peretti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.,Cardiology 4, ASST GOM Niguarda Ca Granda Hospital, Milan, Italy
| | - Giovanni Ferraro
- Internal Medicine Department, ASST GOM Niguarda Ca Granda Hospital, Milan, Italy
| | - Antonio Agrati
- Internal Medicine Department, ASST GOM Niguarda Ca Granda Hospital, Milan, Italy
| | - Fabrizio Colombo
- Internal Medicine Department, ASST GOM Niguarda Ca Granda Hospital, Milan, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.,Cardiology 4, ASST GOM Niguarda Ca Granda Hospital, Milan, Italy
| |
Collapse
|
2
|
Viazzi F, Cappadona F, Leoncini G, Ratto E, Gonnella A, Bonino B, Verzola D, Garibotto G, Pontremoli R. Two-Day ABPM-Derived Indices and Mortality in Hemodialysis Patients. Am J Hypertens 2020; 33:165-174. [PMID: 31605486 DOI: 10.1093/ajh/hpz166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/14/2019] [Accepted: 10/08/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Blood pressure (BP) and arterial stiffness are known cardiovascular risk factors in hemodialysis (HD) patients. This study examines the prognostic significance of 44-hour BP circadian rhythm and ambulatory arterial stiffness index (AASI) in this population. METHODS A total of 80 HD patients underwent 44-hour ambulatory BP monitoring (ABPM) with a TM-2430 monitor during a standard midweek interdialytic interval and followed up for 4.5 ± 1.7 years. The end point was all-cause mortality. RESULTS About 76% of participants were hypertensive (40% uncontrolled), 62% were nondippers, and 23% risers during the first interdialytic day, whereas 73% and 44% in the second day, respectively. During follow-up, 31 patients (40%) died. These showed higher pulse pressure (PP) and AASI44 and AASI of the second interdialytic period. The incidence of all-cause mortality was higher in HD patients with AASI44 > median, i.e. >0.54 (interquartile range = 14) (54% vs. 28%, χ 2 = 5.3, P = 0.021) when compared with those with lower AASI44. Second, but not first-day ABPM-derived parameters, namely nondipping (log-rank χ 2 = 6.10, P = 0.0134) or reverse dipping status (log-rank χ 2 = 5.32, P = 0.210) and arterial stiffness index (log-rank χ 2 = 6.61, P = 0.0101) were significantly related to greater mortality. CONCLUSIONS These findings indicate a strong relationship between arterial stiffness and cardiovascular risk and support a wider use of 44-hour ABPM recording for risk stratification in HD patients.
Collapse
Affiliation(s)
- Francesca Viazzi
- Clinica Nefrologica Dialisi e Trapianto, University of Genova and Ospedale Policlinico San Martino-IST, Genoa, Italy
| | - Francesca Cappadona
- Clinica Nefrologica Dialisi e Trapianto, University of Genova and Ospedale Policlinico San Martino-IST, Genoa, Italy
| | - Giovanna Leoncini
- Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Elena Ratto
- Clinica Nefrologica Dialisi e Trapianto, University of Genova and Ospedale Policlinico San Martino-IST, Genoa, Italy
| | - Annalisa Gonnella
- Clinica Nefrologica Dialisi e Trapianto, University of Genova and Ospedale Policlinico San Martino-IST, Genoa, Italy
| | - Barbara Bonino
- Clinica Nefrologica Dialisi e Trapianto, University of Genova and Ospedale Policlinico San Martino-IST, Genoa, Italy
| | - Daniela Verzola
- Clinica Nefrologica Dialisi e Trapianto, University of Genova and Ospedale Policlinico San Martino-IST, Genoa, Italy
| | - Giacomo Garibotto
- Clinica Nefrologica Dialisi e Trapianto, University of Genova and Ospedale Policlinico San Martino-IST, Genoa, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
3
|
Ašćerić RR, Dimković NB, Trajković GŽ, Ristić BS, Janković AN, Durić PS, Ilijevski NS. Prevalence, clinical characteristics, and predictors of peripheral arterial disease in hemodialysis patients: a cross-sectional study. BMC Nephrol 2019; 20:281. [PMID: 31349820 PMCID: PMC6660935 DOI: 10.1186/s12882-019-1468-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/19/2019] [Indexed: 01/23/2023] Open
Abstract
Background Peripheral arterial disease (PAD) is common in patients with end-stage renal disease on hemodialysis, but is frequently underdiagnosed. The risk factors for PAD are well known within the general population, but they differ somewhat in hemodialysis patients. This study aimed to determine the prevalence of PAD and its risk factors in patients on hemodialysis. Methods This cross-sectional study included 156 hemodialysis patients. Comorbidities and laboratory parameters were analyzed. Following clinical examinations, the ankle-brachial index was measured in all patients. PAD was diagnosed based on the clinical findings, ankle-brachial index < 0.9, and PAD symptoms. Results PAD was present in 55 of 156 (35.3%; 95% CI, 27.7–42.8%) patients. The patients with PAD were significantly older (67 ± 10 years vs. 62 ± 11 years, p = 0.014), more likely to have diabetes mellitus (p = 0.022), and anemia (p = 0.042), and had significantly lower serum albumin (p = 0.005), total cholesterol (p = 0.024), and iron (p = 0.004) levels, higher glucose (p = 0.002) and C-reactive protein (p < 0.001) levels, and lower dialysis adequacies (p = 0.040) than the patients without PAD. Multivariate analysis showed higher C-reactive protein level (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00–1.06; p = 0.030), vascular access by Hickman catheter (OR, 4.66; 95% CI, 1.03–21.0; p = 0.045), and symptoms of PAD (OR, 5.20; 95% CI, 2.60–10.4; p < 0.001) as independent factors associated with PAD in hemodialysis patients. Conclusion The prevalence of PAD was high among patients with end-stage renal disease on hemodialysis. Symptoms of PAD, higher C-reactive protein levels, and Hickman vascular access were independent predictors of PAD in patients on hemodialysis.
Collapse
Affiliation(s)
- Radislav R Ašćerić
- Department of Vascular Surgery Clinic of Surgery, Clinical Hospital Center Zvezdara, Dimitrija Tucovića 161, Belgrade, 11000, Serbia.
| | - Nada B Dimković
- Clinic of Nephrology, Clinical Hospital Center Zvezdara, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Goran Ž Trajković
- Department of Medical Statistics and Informatics Medical Faculty, University of Belgrade, Belgrade, Serbia
| | | | | | - Petar S Durić
- Clinic of Nephrology, Clinical Hospital Center Zvezdara, Belgrade, Serbia
| | - Nenad S Ilijevski
- Medical Faculty, University of Belgrade, Belgrade, Serbia.,Vascular Surgery Clinic, Dedinje Cardiovascular Institute, Belgrade, Serbia
| |
Collapse
|
4
|
Okuyama M, Takeuchi H, Uchida HA, Kakio Y, Okuyama Y, Umebayashi R, Wada K, Sugiyama H, Sugimoto K, Rakugi H, Kasahara S, Wada J. Peripheral artery disease is associated with frailty in chronic hemodialysis patients. Vascular 2018; 26:425-431. [DOI: 10.1177/1708538118756690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The clinical condition of frailty is a common problem in the elderly population. However, the relationship between peripheral artery disease and frailty in hemodialysis patients remains unknown. The aim of this study was to identify the relationships between peripheral artery disease and frailty in Japanese chronic hemodialysis patients. Methods A total of 362 chronic hemodialysis patients who regularly visited six institutions were enrolled. To evaluate frailty, the modified Fried’s frailty phenotype adjusted for Japanese were used. Peripheral artery disease was defined as ankle-brachial index <0.9. Results Of 362 patients, 62 patients (17.1%) were categorized as peripheral artery disease group and 300 patients (82.9%) as Non-peripheral artery disease group. The prevalence of frailty in the peripheral artery disease group was significantly higher than in the Non-peripheral artery disease group (34% vs. 18%, P = 0.0103). Non-shunt side grip strength was significantly stronger in the Non-peripheral artery disease group (23.6 kg vs. 17.0 kg, P < 0.0001). Thigh circumferences were also significantly larger in the Non-peripheral artery disease group (41.7 cm vs. 39.7 cm, P = 0.0054). A multivariate logistic regression analysis demonstrated that the factors independently associated with peripheral artery disease were as follows: frailty (odds ratio = 2.06, 95% confidence interval 1.09–3.89) and myocardial infarction (odds ratio = 3.74, 95% confidence interval 2.05–6.83). Conclusions It is concluded that peripheral artery disease is closely associated with frailty in hemodialysis patients.
Collapse
Affiliation(s)
- Michihiro Okuyama
- Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Internal Medicine, Innoshima General Hospital, Hiroshima, Japan
| | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Kakio
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuka Okuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryoko Umebayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kentaro Wada
- Division of Nephrology and Dialysis, Department of Internal Medicine, Nippon Kokan Fukuyama Hospital, Hiroshima, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ken Sugimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
5
|
Abnormal ankle-brachial index and risk of cardiovascular or all-cause mortality in patients with chronic kidney disease: a meta-analysis. J Nephrol 2017; 30:493-501. [DOI: 10.1007/s40620-017-0376-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022]
|
6
|
Aortic–Radial Pulse Wave Velocity Ratio in End-stage Renal Disease Patients: Association with Age, Body Tissue Hydration Status, Renal Failure Etiology and Five Years of Hemodialysis. High Blood Press Cardiovasc Prev 2017; 24:37-48. [DOI: 10.1007/s40292-017-0178-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022] Open
|