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 journalArticlepeer-review

14 Scopus citations


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 (<0.90), and high (>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
Issue number1
StatePublished - Jan 2015
Externally publishedYes


  • 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


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