Peripheral Artery Disease Increases Adverse Outcomes in CKD

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Patients with moderate to severe kidney disease have a higher risk of peripheral artery disease (PAD) with an increased risk of lower-limb complications and other adverse outcomes, reports a study in the American Journal of Kidney Diseases.

The retrospective analysis used administrative data on nearly 454,000 adult residents of Manitoba, Canada, who had at least one serum creatinine measurement between 2007 and 2014. Based on hospital discharge diagnostic codes and medical claims, 4.5% of patients had a diagnosis of PAD. Associations between PAD and CKD were analyzed, including the impact on lower-limb complications, cardiovascular events, and mortality.

Patients with PAD were older (69.0 versus 50.7 years) and more likely to be male (52.4% versus 44.8%). Grade 3 to 5 CKD was present in 30.0% of patients with PAD, compared to 10.1% of the non-PAD group. Rates of grade 5 CKD requiring dialysis were 3.1% versus 0.4%, respectively. Peripheral arterial disease was also associated with high rates of other comorbid conditions, including chronic pulmonary disease, diabetes, and cardiovascular/cerebrovascular disease.

Patients with PAD were at increased risk for all-cause mortality, cardiovascular events, and lower-limb complications, in all eGFR categories. The risk of lower-limb complications was 10 to 12 times higher for patients with grade 5 CKD requiring dialysis, compared to patients with normal kidney function who were free of PAD. Among patients with CKD grade 3 to 5, the hazard ratio for lower-limb complications increased from 2.12 for patients without CKD to 6.61 for those with CKD.

Peripheral artery disease is a common and burdensome complication among patients with CKD—largely related to foot complications. Few studies have examined the prevalence of PAD and associated adverse outcomes among patients with CKD not requiring kidney replacement therapy.

The new findings show a high prevalence of PAD among patients with grade 3 or higher CKD. The presence of PAD in patients with CKD is a “potent risk factor” for lower-limb complications, cardiovascular events, and death. The authors call for trials of screening and treatment strategies to address the “extreme risk” of lower-limb amputation or ulceration in dialysis patients with PAD [Bourrier M, et al. Peripheral artery disease: its adverse consequences with and without CKD. Am J Kidney Dis 2019; DOI: 10.1053/j.ajkd.2019.08.028].