Risk Factors of Arterial Damage Assessed by ABI and baPWV among Hemodialysis Patients in Macau

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity among patients with ESRD on chronic dialysis. Arterial damage is one of the characteristics of CVD. But the association between arterial damage and conventional risk factors for CVD has not yet been fully highlighted in chronic hemodialysis patients. Here we validate the clinical value of assessment of arterial damage by ABI and PWV in chronic hemodialysis patients in Macau. 1. Background Cardiovascular disease (CVD) is the leading cause of mortality and morbidity among patients with ESRD on chronic dialysis [1]. According to the US Renal Data System and Hong Kong Renal Registry reports, CVD accounts for approximately 40% of mortality in dialysis patients [2, 3]. Arterial damage, including stenosis and stiffness of arteries, is one of the characteristics of CVD. Several noninvasive measurements are introduced to identify the abnormal structure and function of arteries [4]. Ankle-brachial index (ABI) serves as a reliable sign for diagnosing peripheral artery disease. A reduced ABI relates to further development of angina, myocardial infarction, stroke, and need for coronary bypass surgery. And it is a powerful independent predictor of all-cause and cardiovascular mortality in hemodialysis (HD) patients [5, 6]. Pulse wave velocity (PWV), which provides a comprehensive assessment of arterial stiffness, is also a powerful and independent predictor of all-cause and cardiovascular mortality in ESRD patients [7, 8]. Classic cardiovascular risk factors, such as blood pressure, diabetes mellitus, and hyperlipidemia, have been implicated in accelerated arterial damage. However, findings of many studies in general population were inconsistent with respect to risk factors other than age and blood pressure [9]. And the association between arterial damage and those risk factors has not yet been fully highlighted in chronic hemodialysis patients. In consideration of the genetic contribution to arterial damage [10], it is meaningful to validate the clinical value of assessment of arterial damage by ABI and PWV in chronic hemodialysis patients in Macau. 2. Methods 2.1. Subjects We retrospectively studied all chronic HD patients who were aboriginal inhabitants of Macau (all of the enrolled patients were born in Macau and in most of time they lived in Macau) in this cross-sectional study from March 2012 to June 2012. Patients who met the following criteria were enrolled. Entry Criteria. These include age of 18 or older, 1 year or more of duration of dialysis, and dry weight being kept stable for