Combined Effect of Chronic Kidney Disease and Peripheral Arterial Disease on All-Cause Mortality in a High-Risk Population

Chronic kidney disease (CKD) and peripheral arterial disease (PAD) share common risk factors. We assessed renal function and the prevalence of CKD in patients with PAD and investigated the characteristics of the risk factors for CKD in this population. Renal function of 421 patients with PAD was evaluated. Among the participants, 194 (46.1%) patients had decreased estimated glomerular filtration rate (eGFR). The prevalence of CKD was much higher among patients with PAD. Hypertension (odds ratios [ORs] 2.156, 95% confidence interval [CI] 1.413-3.289, P < .001), serum uric acid (OR 3.794, 95% CI 2.220-6.450, P < .001), and dyslipidemia (OR 1.755, 95% CI 1.123-2.745, P = .014) were significantly associated with CKD and the independent risk factors for CKD in patients with PAD. CKD is common and has a high prevalence in a population with PAD. Patients with PAD may be considered as a high-risk population for CKD. Recognition and modification of risk factors for CKD might beneficially decrease CKD incidence and improve prognosis in patients with PAD.

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Familial Hypercholesterolemia and Risk of Peripheral Arterial Disease and Chronic Kidney Disease

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-01058 ◽

2018 ◽

Vol 103 (12) ◽

pp. 4491-4500 ◽

Cited By ~ 13

Author(s):

Frida Emanuelsson ◽

Børge G Nordestgaard ◽

Marianne Benn

Keyword(s):

Myocardial Infarction ◽

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Peripheral Arterial Disease ◽

Familial Hypercholesterolemia ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Artery Disease ◽

Peripheral Arterial

Abstract Context Individuals with familial hypercholesterolemia (FH) have a high risk of coronary artery disease, but their risk of peripheral arterial disease (PAD) and chronic kidney disease (CKD) is unknown. Objective In individuals with clinical FH, we tested the hypotheses (1) that the risks of PAD and CKD are elevated and (2) that low ankle-brachial index (ABI) and estimated glomerular filtration rate (eGFR) are associated with a high risk of myocardial infarction. Design and Setting Prospective cohort study of the general population. Participants A total of 106,172 individuals, of whom 7109 were diagnosed with FH. Main Outcome Measures PAD, CKD, and myocardial infarction. Results Compared with individuals with unlikely FH, multivariable adjusted ORs (95% CIs) of PAD were 1.84 (1.70 to 2.00) in those with possible FH and 1.36 (1.00 to 1.84) in individuals with probable/definite FH. For CKD, the corresponding ORs (95% CIs) were 1.92 (1.78 to 2.07) and 2.42 (1.86 to 3.26). Compared with individuals with unlikely FH and ABI >0.9, the multivariable adjusted hazard ratio (95% CI) of myocardial infarction was 4.60 (2.36 to 8.97) in those with possible/probable/definite FH and ABI ≤0.9. Compared with individuals with unlikely FH and eGFR ≥60 mL/min/1.73 m2, the corresponding value was 2.19 (1.71 to 2.82) in those with possible/probable/definite FH and eGFR <60 mL/min/1.73 m2. Conclusions Individuals with clinical FH have increased risks of PAD and CKD, and low ABI and eGFR are associated with high risk of myocardial infarction. Consequently, individuals with FH should be screened for PAD and CKD, and ABI and eGFR may be used as prognostic tools in the management and treatment of FH to identify those at very high risk of myocardial infarction.

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The influence of the obesity paradox and chronic kidney disease on long-term survival in a Japanese cohort with peripheral arterial disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.02.008 ◽

2010 ◽

Vol 52 (1) ◽

pp. 110-117 ◽

Cited By ~ 50

Author(s):

Hisao Kumakura ◽

Hiroyoshi Kanai ◽

Masahiro Aizaki ◽

Kito Mitsui ◽

Yoshihiro Araki ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Peripheral Arterial Disease ◽

Obesity Paradox ◽

Arterial Disease ◽

Term Survival ◽

Long Term Survival ◽

Japanese Cohort ◽

Peripheral Arterial

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Epidemiology and Diagnosis of Peripheral Arterial Disease in Patients With Chronic Kidney Disease

Advances in Chronic Kidney Disease ◽

10.1053/j.ackd.2008.07.007 ◽

2008 ◽

Vol 15 (4) ◽

pp. 378-383 ◽

Cited By ~ 19

Author(s):

Joachim H. Ix ◽

Michael H. Criqui

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Peripheral Arterial

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Traditional and non-traditional risk factors for incident peripheral arterial disease among patients with chronic kidney disease

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfv418 ◽

2015 ◽

Vol 31 (7) ◽

pp. 1145-1151 ◽

Cited By ~ 23

Author(s):

Jing Chen ◽

Emile R. Mohler ◽

Dawei Xie ◽

Michael Shlipak ◽

Raymond R. Townsend ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Traditional Risk Factors ◽

Peripheral Arterial

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Vascular calcification score on plain radiographs of the feet as a predictor of peripheral arterial disease in patients with chronic kidney disease

International Urology and Nephrology ◽

10.1007/s11255-009-9697-8 ◽

2009 ◽

Vol 42 (3) ◽

pp. 773-780 ◽

Cited By ~ 18

Author(s):

Won Suk An ◽

Young Ki Son ◽

Seong-Eun Kim ◽

Ki-Hyun Kim ◽

Seong Kuk Yoon ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Peripheral Arterial Disease ◽

Vascular Calcification ◽

Arterial Disease ◽

Plain Radiographs ◽

Calcification Score ◽

Peripheral Arterial

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Abstract 20579: Chronic Kidney Disease is Associated With Increased Mortality and Major Adverse Cardiovascular Events in Patients With Peripheral Arterial Disease

Circulation ◽

10.1161/circ.130.suppl_2.20579 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Gregory G Westin ◽

Ehrin J Armstrong ◽

Debbie C Chen ◽

John R Laird

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Peripheral Arterial Disease ◽

Cardiovascular Events ◽

Cox Model ◽

Univariate Analysis ◽

Arterial Disease ◽

Major Adverse Cardiovascular Events ◽

Ckd Stage ◽

Peripheral Arterial

Introduction: Chronic kidney disease (CKD) is common in patients with peripheral arterial disease (PAD), but patients with severe CKD have been excluded from many trials and no objective performance goals exist for patients with PAD and CKD. We sought to analyze the association between severity of CKD and cardiovascular and limb-related outcomes among patients with PAD. Methods: We reviewed records of all patients at our institution who underwent lower extremity angiography between 2006 and 2013. We analyzed outcomes including mortality, major adverse cardiovascular event (MACE) rate, and major adverse limb event (MALE) rate according to clinical stage of CKD, determined by calculating each patient’s glomerular filtration rate using the Cockcroft-Gault equation. We used Cox proportional hazard modeling to account for covariates, along with Bonferroni correction for multiple comparisons. Results: Of 773 patients, 45% had CKD stage 3-5. The patients had a median age of 67, were 58% male, 51% diabetic, and 57% presented with critical limb ischemia (CLI). During a median follow-up time of 3.2 years, patients with higher stages of CKD had an increased rate of death (Figure 1, p<0.001). CKD stages 4 and 5 were significant predictors of mortality in a multivariate model (HR 3.2 and 2.4 vs. CKD 1, P<0.001 and P<0.01, respectively). An analysis of MACE by CKD stage demonstrated similar results (CKD 4 HR 2.2, p<0.01; CKD 5 HR 2.0, p<0.01). CKD stage also predicted MALE in a univariate analysis (p<0.01), driven by increased limb events among patients with CKD stage 5 (p<0.01). However, CKD stage did not demonstrate a significantly increased hazard of MALE in a multivariate Cox model. Conclusions: Patients with PAD who also have CKD have increased rates of adverse outcomes. This relationship seems to be more robust for major cardiovascular events and overall mortality than for major limb events. Future studies should investigate how management of PAD should differ for patients with CKD.

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