Introduction
Chronic Kidney Disease (CKD) is becoming a public health concern worldwide due to its association with increased morbidity and mortality and its role as a risk factor for cardiovascular (CV) events. Identifying predictors of CKD could enhance early detection and intervention, thus possibly preventing the progression to end-stage renal disease and reducing CV risks. The Ankle-Brachial Index (ABI), a measure of peripheral artery disease, has been studied as a prognostic marker for CKD in Western populations. However, its predictive value in Asian populations has not been as extensively examined.
In a bid to fill this knowledge gap, an investigation into the relationship between ABI and the risk of incident CKD in a general Japanese population was conducted by Sonoda Hiroshi H, Nakamura Koshi K, and Tamakoshi Akiko A from the Department of Public Health, Hokkaido University Graduate School and Faculty of Medicine, and published on December 1, 2019, in the Journal of Atherosclerosis and Thrombosis (DOI: 10.5551/jat.47779).
The cohort study included 5,072 Japanese participants aged 30-79 years who had no prior history of renal or cerebro-cardiovascular disease. Participants underwent ABI measurement and were followed up for a mean period of 5.1 years to determine the incidence of CKD, defined as an estimated glomerular filtration rate ＜60 mL/min/1.73 m2.
Results revealed an overall CKD incidence rate of 1.80 per 100 person-years. Notably, there was a higher incidence rate in participants with ABI in the ranges of 0.90-0.99 and 1.30-1.39, both considered outside the normal range of 1.00-1.29. After adjusting for potential confounders such as age, sex, systolic blood pressure, and diabetes, an ABI of 0.90-0.99 was significantly associated with an increased risk of developing incident CKD, having a hazard ratio of 2.14 (95% confidence interval 1.16-3.92).
Discussion
The findings of the present study are consistent with previous research indicating an association between reduced ABI—which is indicative of peripheral artery disease—and an increased risk of CKD. The pathophysiological link may be explained by the atherogenic profile associated with CKD, which shares common risk factors with peripheral arterial disease.
The study’s findings are supported by prior works, including a meta-analysis conducted by Lin et al. (2013) [Ann Intern Med, 159: 333-341. DOI: 10.7326/0003-4819-159-5-201309030-00008] examining ABI’s role in peripheral artery disease screening and CV disease prediction, illustrating the multifaceted implications of ABI measurements beyond peripheral artery health.
Implications for Clinical Practice
Incorporating ABI measurement into routine health assessments for the Japanese population could lead to early identification of individuals at risk for CKD, allowing for timely interventions. Clinicians may consider ABI as part of a comprehensive CV and kidney risk assessment, especially in patients showing other risk factors such as hypertension or diabetes.
Limitations and Future Research
Limitations of this study include the inability to establish causation due to its observational nature, as well as potential selection bias since participants with a history of renal or CV disease were excluded. Furthermore, ABI measurements were only taken at baseline, and changes over time were not accounted for. These findings need to be confirmed in other populations, and prospective studies should consider serial ABI measurements to further elucidate the relationship between ABI and CKD progression.
Conclusion
This landmark study conducted in a general Japanese population has substantial implications for public health and clinical practice. The observed association between abnormal ABI measurements and the risk of incident CKD posits ABI as a valuable predictive marker and could lead to refined strategies for CKD prevention and management, particularly in this geographical demographic.
References
1. Lin JS, Olson CM, Johnson ES, Whitlock EP. The ankle-brachial index for peripheral artery disease screening and cardiovascular disease prediction among asymptomatic adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;159(5):333-341. DOI: 10.7326/0003-4819-159-5-201309030-00008
2. Sonoda Hiroshi H, Nakamura Koshi K, Tamakoshi Akiko A. Ankle-Brachial Index is a Predictor of Future Incident Chronic Kidney Disease in a General Japanese Population. J Atheroscler Thromb. 2019;26(12):1054-1061. DOI: 10.5551/jat.47779
3. O’Hare AM, Rodriguez RA, Bacchetti P. Low ankle-brachial index associated with rise in creatinine level over time: results from the atherosclerosis risk in communities study. Arch Intern Med. 2005;165(14):1481-1485. DOI: 10.1001/archinte.165.14.1481
4. Foster MC, Ghuman N, Hwang SJ, Murabito JM, Fox CS. Low ankle-brachial index and the development of rapid estimated GFR decline and CKD. Am J Kidney Dis. 2013;61(2):204-210. DOI: 10.1053/j.ajkd.2012.07.020
5. Criqui MH, McClelland RL, McDermott MM, et al. The ankle-brachial index and incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2010;56(18):1506-1512. DOI: 10.1016/j.jacc.2010.06.043
Keywords
1. Ankle-Brachial Index Chronic Kidney Disease
2. ABI Predictor CKD Risk
3. ABI Measurement Japanese Population
4. CKD Incidence Rate Japan
5. Peripheral Artery Disease CKD Predictor