Association of albumin-creatinine ratio and cystatin C with change in ankle-brachial index: The multi-ethnic study of atherosclerosis (MESA)

Pranav S. Garimella, Joachim H. Ix, Ronit Katz, Michael G. Shlipak, Michael H. Criqui, David S. Siscovick, Holly Kramer, Christopher T. Sibley, Mark J. Sarnak

Research output: Contribution to journalArticle

Abstract

Background: Low ankle-brachial index (ABI) is a reflection of atherosclerotic disease, and high ABI is an indicator of calcified vessels. The associations of albuminuria and cystatin C level with incidence of either low or high ABI are unknown. Study Design: Prospective longitudinal cohort study. Setting & Participants: MESA (Multi-Ethnic Study of Atherosclerosis) enrolled community-dwelling adults (N = 6,814) aged 45-84 years who were free of clinical cardiovascular disease at baseline. Predictors: Baseline albumin-creatinine ratio (ACR) and serum cystatin C level. Outcomes: Development of low (1.40) ABI using multinomial regression among persons with ABI of 0.90-1.40 at baseline. Results: During 9.8 years of follow-up, 221 and 89 participants progressed to low and high ABIs, respectively. Baseline ACR and cystatin C level were higher among progressors compared with nonprogressors. In multivariable analyses, doubling of ACR was associated with increased risk of progression to low (OR, 1.08; 95% CI, 0.99-1.20) and high (OR, 1.16; 95% CI, 1.01-1.32) ABIs. Compared to the lowest quintile, the highest quintile of ACR had a significantly increased risk of progression to low (OR, 1.79; 95% CI, 1.03-3.12) and high (OR, 2.76; 95% CI, 1.32-5.77) ABIs. Higher cystatin C levels were associated with progression to low (OR per 1-SD greater, 1.12; 95% CI, 1.00-1.26) but not high (OR per 1-SD greater, 1.01; 95% CI, 0.81-1.25) ABI, but the highest quintile of cystatin C was not associated independently with either outcome. Limitations: Single measure of albuminuria and low number of progressors to high ABI. Conclusions: In adults free of clinical cardiovascular disease, albuminuria was a strong independent risk factor for the development of both high and low ABIs, important and different measures of peripheral artery disease.

Original languageEnglish (US)
Pages (from-to)33-40
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume65
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

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Cystatin C
Ankle Brachial Index
Albumins
Creatinine
Atherosclerosis
Albuminuria
Cardiovascular Diseases
Independent Living
Peripheral Arterial Disease
Longitudinal Studies
Cohort Studies
Prospective Studies
Incidence
Serum

Keywords

  • Albumin-creatinine ratio (ACR)
  • Albuminuria
  • Ankle-brachial index (ABI)
  • Atherosclerotic disease
  • Cardiovascular disease (CVD)
  • Chronic kidney disease (CKD)
  • Cystatin C
  • Peripheral artery disease (PAD)

ASJC Scopus subject areas

  • Nephrology

Cite this

Association of albumin-creatinine ratio and cystatin C with change in ankle-brachial index : The multi-ethnic study of atherosclerosis (MESA). / Garimella, Pranav S.; Ix, Joachim H.; Katz, Ronit; Shlipak, Michael G.; Criqui, Michael H.; Siscovick, David S.; Kramer, Holly; Sibley, Christopher T.; Sarnak, Mark J.

In: American Journal of Kidney Diseases, Vol. 65, No. 1, 2014, p. 33-40.

Research output: Contribution to journalArticle

Garimella, PS, Ix, JH, Katz, R, Shlipak, MG, Criqui, MH, Siscovick, DS, Kramer, H, Sibley, CT & Sarnak, MJ 2014, 'Association of albumin-creatinine ratio and cystatin C with change in ankle-brachial index: The multi-ethnic study of atherosclerosis (MESA)', American Journal of Kidney Diseases, vol. 65, no. 1, pp. 33-40. https://doi.org/10.1053/j.ajkd.2014.05.014
Garimella, Pranav S. ; Ix, Joachim H. ; Katz, Ronit ; Shlipak, Michael G. ; Criqui, Michael H. ; Siscovick, David S. ; Kramer, Holly ; Sibley, Christopher T. ; Sarnak, Mark J. / Association of albumin-creatinine ratio and cystatin C with change in ankle-brachial index : The multi-ethnic study of atherosclerosis (MESA). In: American Journal of Kidney Diseases. 2014 ; Vol. 65, No. 1. pp. 33-40.
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abstract = "Background: Low ankle-brachial index (ABI) is a reflection of atherosclerotic disease, and high ABI is an indicator of calcified vessels. The associations of albuminuria and cystatin C level with incidence of either low or high ABI are unknown. Study Design: Prospective longitudinal cohort study. Setting & Participants: MESA (Multi-Ethnic Study of Atherosclerosis) enrolled community-dwelling adults (N = 6,814) aged 45-84 years who were free of clinical cardiovascular disease at baseline. Predictors: Baseline albumin-creatinine ratio (ACR) and serum cystatin C level. Outcomes: Development of low (1.40) ABI using multinomial regression among persons with ABI of 0.90-1.40 at baseline. Results: During 9.8 years of follow-up, 221 and 89 participants progressed to low and high ABIs, respectively. Baseline ACR and cystatin C level were higher among progressors compared with nonprogressors. In multivariable analyses, doubling of ACR was associated with increased risk of progression to low (OR, 1.08; 95{\%} CI, 0.99-1.20) and high (OR, 1.16; 95{\%} CI, 1.01-1.32) ABIs. Compared to the lowest quintile, the highest quintile of ACR had a significantly increased risk of progression to low (OR, 1.79; 95{\%} CI, 1.03-3.12) and high (OR, 2.76; 95{\%} CI, 1.32-5.77) ABIs. Higher cystatin C levels were associated with progression to low (OR per 1-SD greater, 1.12; 95{\%} CI, 1.00-1.26) but not high (OR per 1-SD greater, 1.01; 95{\%} CI, 0.81-1.25) ABI, but the highest quintile of cystatin C was not associated independently with either outcome. Limitations: Single measure of albuminuria and low number of progressors to high ABI. Conclusions: In adults free of clinical cardiovascular disease, albuminuria was a strong independent risk factor for the development of both high and low ABIs, important and different measures of peripheral artery disease.",
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T1 - Association of albumin-creatinine ratio and cystatin C with change in ankle-brachial index

T2 - The multi-ethnic study of atherosclerosis (MESA)

AU - Garimella, Pranav S.

AU - Ix, Joachim H.

AU - Katz, Ronit

AU - Shlipak, Michael G.

AU - Criqui, Michael H.

AU - Siscovick, David S.

AU - Kramer, Holly

AU - Sibley, Christopher T.

AU - Sarnak, Mark J.

PY - 2014

Y1 - 2014

N2 - Background: Low ankle-brachial index (ABI) is a reflection of atherosclerotic disease, and high ABI is an indicator of calcified vessels. The associations of albuminuria and cystatin C level with incidence of either low or high ABI are unknown. Study Design: Prospective longitudinal cohort study. Setting & Participants: MESA (Multi-Ethnic Study of Atherosclerosis) enrolled community-dwelling adults (N = 6,814) aged 45-84 years who were free of clinical cardiovascular disease at baseline. Predictors: Baseline albumin-creatinine ratio (ACR) and serum cystatin C level. Outcomes: Development of low (1.40) ABI using multinomial regression among persons with ABI of 0.90-1.40 at baseline. Results: During 9.8 years of follow-up, 221 and 89 participants progressed to low and high ABIs, respectively. Baseline ACR and cystatin C level were higher among progressors compared with nonprogressors. In multivariable analyses, doubling of ACR was associated with increased risk of progression to low (OR, 1.08; 95% CI, 0.99-1.20) and high (OR, 1.16; 95% CI, 1.01-1.32) ABIs. Compared to the lowest quintile, the highest quintile of ACR had a significantly increased risk of progression to low (OR, 1.79; 95% CI, 1.03-3.12) and high (OR, 2.76; 95% CI, 1.32-5.77) ABIs. Higher cystatin C levels were associated with progression to low (OR per 1-SD greater, 1.12; 95% CI, 1.00-1.26) but not high (OR per 1-SD greater, 1.01; 95% CI, 0.81-1.25) ABI, but the highest quintile of cystatin C was not associated independently with either outcome. Limitations: Single measure of albuminuria and low number of progressors to high ABI. Conclusions: In adults free of clinical cardiovascular disease, albuminuria was a strong independent risk factor for the development of both high and low ABIs, important and different measures of peripheral artery disease.

AB - Background: Low ankle-brachial index (ABI) is a reflection of atherosclerotic disease, and high ABI is an indicator of calcified vessels. The associations of albuminuria and cystatin C level with incidence of either low or high ABI are unknown. Study Design: Prospective longitudinal cohort study. Setting & Participants: MESA (Multi-Ethnic Study of Atherosclerosis) enrolled community-dwelling adults (N = 6,814) aged 45-84 years who were free of clinical cardiovascular disease at baseline. Predictors: Baseline albumin-creatinine ratio (ACR) and serum cystatin C level. Outcomes: Development of low (1.40) ABI using multinomial regression among persons with ABI of 0.90-1.40 at baseline. Results: During 9.8 years of follow-up, 221 and 89 participants progressed to low and high ABIs, respectively. Baseline ACR and cystatin C level were higher among progressors compared with nonprogressors. In multivariable analyses, doubling of ACR was associated with increased risk of progression to low (OR, 1.08; 95% CI, 0.99-1.20) and high (OR, 1.16; 95% CI, 1.01-1.32) ABIs. Compared to the lowest quintile, the highest quintile of ACR had a significantly increased risk of progression to low (OR, 1.79; 95% CI, 1.03-3.12) and high (OR, 2.76; 95% CI, 1.32-5.77) ABIs. Higher cystatin C levels were associated with progression to low (OR per 1-SD greater, 1.12; 95% CI, 1.00-1.26) but not high (OR per 1-SD greater, 1.01; 95% CI, 0.81-1.25) ABI, but the highest quintile of cystatin C was not associated independently with either outcome. Limitations: Single measure of albuminuria and low number of progressors to high ABI. Conclusions: In adults free of clinical cardiovascular disease, albuminuria was a strong independent risk factor for the development of both high and low ABIs, important and different measures of peripheral artery disease.

KW - Albumin-creatinine ratio (ACR)

KW - Albuminuria

KW - Ankle-brachial index (ABI)

KW - Atherosclerotic disease

KW - Cardiovascular disease (CVD)

KW - Chronic kidney disease (CKD)

KW - Cystatin C

KW - Peripheral artery disease (PAD)

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