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BACKGROUND: The ankle-brachial index (ABI) is a noninvasive method to evaluate peripheral artery disease (PAD). ABI <0.9 diagnoses PAD; ABI >1.3 is a false negative caused by noncompressible arteries. The aim of this study is to evaluate the association between ABI with vascular calcifications (VC) and with mortality, in haemodialysis (HD) patients. METHODS: We studied 219 HD patients (60% male; 20% diabetic). At baseline, ABI was evaluated by a Doppler device. VCs were evaluated by two methods: the abdominal aorta calcification score (AACS) in a lateral plain X-ray of the abdominal aorta and the simple vascular calcification score (SVCS) in plain X-rays of the pelvis and hands. VC were also classified by their anatomical localization in main vessels (aorta and iliac-femoral axis) and in peripheral or distal vessels (pelvic, radial or digital). The cutoff values for the different VC scores in relation with ABI were determined by receiver operating characteristic curve analysis. Biochemical parameters were time averaged for the 6 months preceding ABI evaluation. RESULTS: An ABI <0.9, an ABI >1.3 or a normal ABI were found, respectively, in 90 (41%), in 42 (19%) and in 87 (40%) patients. AACS ≥6 and SVCS >3 were found, respectively, in 98 (45%) and 95 (43%) patients. The adjusted odds ratio (OR) for having an ABI <0.9 was 2.5 (P = 0.007) for AACS ≥6 and 4.5 (P < 0.001) for iliac-femoral calcification score (CS) ≥2. The adjusted OR for having an ABI >1.3 was 4.2 (P = 0.003) for pelvic CS and 3.7 (P = 0.006) for hand CS ≥2. During an observational period of 28.9 months, all-cause and cardiovascular mortality occurred, respectively, in 50 (23%) and in 29 (13%) patients. Adjusting for age, diabetes, P levels, HD duration and cardiovascular disease at baseline, an ABI <0.9 [hazard ratio (HR) = 3.9, P < 0.001] and an ABI >1.3 (HR = 2.7, P = 0.038) were associated with all-cause mortality; an ABI <0.9 (HR = 7.2, P = 0.002) and an ABI >1.3 (HR = 5.1, P = 0.028) were associated with cardiovascular mortality. CONCLUSIONS: Both low and high ABI were independent predictors of all-cause and cardiovascular mortality. VC in main arteries were associated with an ABI <0.9. VC in peripheral and distal arteries were associated with an ABI >1.3. ABI is a simple and noninvasive method that allows the identification of high cardiovascular risk patients.

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OBJECTIVES: To analyze the clinical characteristics of septic acute kidney injury (AKI) according to the Acute Kidney Injury Network (AKIN) classification, and to evaluate the capacity of this system in predicting in-hospital mortality of septic patients. METHODS: Patients with sepsis admitted to the infectious diseases intensive care unit (ICU) of our hospital between January 2004 and June 2007 were retrospectively studied. Maximum AKIN stage within the first three days of hospitalization was recorded. RESULTS: Three hundred fifteen patients were evaluated. According to AKIN criteria, 99 patients (31.4%) had AKI: 26.2% at stage 1, 20.2% at stage 2, and 53.6% at stage 3. Four patients (1.9%) with no AKI progressed to stage 1, two patients (7.7%) at stage 1 progressed to stage 2, one patient (3.8%) at stage 1 progressed to stage 3, and one patient at stage 2 (5%) progressed to stage 3. The mortality rate was 25.3% and increased significantly from normal renal function to stage 3 (normal, 12.5%; stage 1, 34.6%; stage 2, 45%; stage 3, 64.1%; p<0.0001). After adjusting for age, gender, race, pre-existing chronic kidney disease, illness severity as evaluated by acute physiology and chronic health evaluation, version II (APACHE II) score, need for mechanical ventilation, and vasopressor use, AKIN stage 1 (odds ratio (OR) 3.03, 95% confidence interval (CI) 1.12-8.19, p=0.029), stage 2 (OR 3.3, 95% CI 1.11-9.78, p=0.031), and stage 3 (OR 7.35, 95% CI 3.13-17.25, p<0.0001) predicted mortality. CONCLUSIONS: AKIN criteria are a useful tool to characterize and stratify septic patients according to the risk of death.

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The objective of this study was to evaluate the correlation of bone mineral density (BMD), evaluated by DXA, with vascular calcifications, arterial stiffness, and vascular disease in patients on peritoneal dialysis. Vascular calcifications were evaluated by vascular calcification score on plain x ray, and arterial stiffness was measured by pulse wave velocity using the Complior device (Artech Medical, Pantin, France). Adjusting for multiple factors, lower BMD at the femoral neck, but not at the lumbar spine, was associated with higher pulse wave velocity (p = 0.037), higher vascular calcification score (p = 0.013), and peripheral artery disease (p = 0.006). These data reinforce the hypothesis of the existence of a link between bone disease and cardiovascular disease in dialysis patients.

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INTRODUCTION: Whether discernible advantages in terms of sensitivity and specificity exist with Acute Kidney Injury Network (AKIN) criteria versus Risk, Injury, Failure, Loss of Kidney Function, End-stage Kidney Disease (RIFLE) criteria is currently unknown. We evaluated the incidence of acute kidney injury and compared the ability of the maximum RIFLE and of the maximum AKIN within intensive care unit hospitalization in predicting inhospital mortality of critically ill patients. METHODS: Patients admitted to the Department of Intensive Medicine of our hospital between January 2003 and December 2006 were retrospectively evaluated. Chronic kidney disease patients undergoing dialysis or renal transplant patients were excluded from the analysis. RESULTS: In total, 662 patients (mean age, 58.6 +/- 19.2 years; 392 males) were evaluated. AKIN criteria allowed the identification of more patients as having acute kidney injury (50.4% versus 43.8%, P = 0.018) and classified more patients with Stage 1 (risk in RIFLE) (21.1% versus 14.7%, P = 0.003), but no differences were observed for Stage 2 (injury in RIFLE) (10.1% versus 11%, P = 0.655) and for Stage 3 (failure in RIFLE) (19.2% versus 18.1%, P = 0.672). Mortality was significantly higher for acute kidney injury defined by any of the RIFLE criteria (41.3% versus 11%, P < 0.0001; odds ratio = 2.78, 95% confidence interval = 1.74 to 4.45, P < 0.0001) or of the AKIN criteria (39.8% versus 8.5%, P < 0.0001; odds ratio = 3.59, 95% confidence interval = 2.14 to 6.01, P < 0.0001). The area under the receiver operator characteristic curve for inhospital mortality was 0.733 for RIFLE criteria (P < 0.0001) and was 0.750 for AKIN criteria (P < 0.0001). There were no statistical differences in mortality by the acute kidney injury definition/classification criteria (P = 0.72). CONCLUSIONS: Although AKIN criteria could improve the sensitivity of the acute kidney injury diagnosis, it does not seem to improve on the ability of the RIFLE criteria in predicting inhospital mortality of critically ill patients.

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Acute renal failure (ARF) is common among hospitalized HIV-infected patients. To our knowledge, however, data regarding ARF in HIV-infected patients in the intensive care unit are still lacking.

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