The ankle to arm blood pressure index (AABI) has been recently found to be a strong predictor of cardiovascular and overall mortality in several populations. The test, which is a noninvasive marker for lower extremity vascular disease (when the index is < 0.9), is an office procedure that is simple to perform. The purpose of this study was to evaluate the AABI in hemodialysis patients. One hundred seventy-seven hemodialysis patients were studied, of which the AABI could be measured in 142. The AABI was then compared in patients with and without coronary artery disease, cerebrovascular disease, and peripheral vascular disease. In patients with or without coronary artery disease, the AABI was, respectively, 0.87 +/- 0.03 and 1.03 +/- 0.02 (P < 0.0001). For cerebrovascular disease, the mean AABI for patients with or without disease was, respectively, 0.82 +/- 0.04 and 1.00 +/- 0.02 (P < 0.0004). In patients with or without peripheral vascular disease, the mean AABI was, respectively, 0.75 +/- 0.04 and 1.02 +/- 0.02 (P < 0.0001). The mean AABI was 0.86 +/- 0.03 in patients with any of the three diseases compared with 1.07 +/- 0.02 in patients without any vascular disease (P < 0.0001). Thirty-eight percent of patients had an AABI of less than 0.9; 24% were less than 0.8 and 11% were less than 0.7.(ABSTRACT TRUNCATED AT 250 WORDS)