Association of body mass index and left ventricular mass index with abnormally low and high ankle-brachial indices in chronic kidney disease

Obesity, left ventricular hypertrophy (LVH) and peripheral artery disease are frequently noted in patients with chronic kidney disease (CKD), thereby suggesting a close and causal relationship among them. This study was designed to assess whether the combination of an increased body mass index (BMI) and left ventricular mass index (LVMI) are independently associated with abnormally low and high ABI in patients with CKD stages 3-5. A total of 566 patients were included in the study and were classified into four groups according to sex-specific median BMIs and LVMIs. The ABI was measured using an ABI-form device. Abnormally low and high ABI was defined as ABI <0.9 or >= 1.3 in either leg. The combination of high BMI and LVMI (vs. the combination of low BMI and LVMI) was significantly associated with abnormally low and high ABI in an unadjusted model (odds ratio (OR), 2.107; P=0.015) and in a multivariable model after adjustment for demographic, clinical and biochemical characteristics and medications (OR, 4.219; P=0.008). In addition, the interaction between BMI and LVMI in abnormally low and high ABI was statistically significant in the unadjusted (OR, 1.002; P=0.001) and multivariate models (OR, 1.004; P=0.003). Our findings show that the combination of high BMI and LVMI was associated with abnormally low and high ABI in patients with CKD stages 3-5. Patients with high BMI and LVMI might be at a high risk of abnormally low and high ABI.