scholarly journals Indoxyl Sulfate and Incident Peripheral Artery Disease in Hemodialysis Patients

Toxins ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 696
Author(s):  
Ting-Yun Lin ◽  
Hsin-Hua Chou ◽  
Hsuan-Li Huang ◽  
Szu-Chun Hung
Keyword(s):  
Peripheral Artery Disease ◽  
Proportional Hazards ◽  
Ankle Brachial Index ◽  
Hemodialysis Patients ◽  
Cox Proportional Hazards ◽  
Indoxyl Sulfate ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
All Cause Mortality ◽  
Artery Disease

Peripheral artery disease (PAD) is highly prevalent among patients with chronic kidney disease (CKD) and portends a very poor prognosis. Indoxyl sulfate has been shown to induce atherothrombosis and impaired neovascularization in uremic mice. However, there is no clinical evidence regarding the role of indoxyl sulfate in PAD associated with CKD. We examined associations between indoxyl sulfate and incident symptomatic lower extremity PAD events as well as major adverse cardiovascular events (MACE) and all-cause mortality using Cox proportional hazards models in a prospective cohort of 200 hemodialysis patients free of PAD at baseline. Patients were considered as having PAD if they developed PAD symptoms confirmed by an ankle-brachial index with waveforms, duplex ultrasound or angiography, and/or major adverse limb events including revascularization and amputation. During a median follow-up of 6.5 years, 37 patients (18.5%) experienced incident symptomatic PAD. MACE occurred in 52 patients, and a total of 85 patients died. After adjusting for traditional risk factors for PAD, including age, current smoking, diabetes, and cardiovascular disease, indoxyl sulfate was significantly associated with the risk of PAD (hazard ratio (HR), 1.19 for every 10-μg/mL increase in indoxyl sulfate; 95% confidence interval (CI), 1.05–1.35). However, indoxyl sulfate was not associated with risk of MACE (HR, 1.00; 95% CI, 0.90–1.12) or death from any cause (HR, 0.98; 95% CI, 0.90–1.07). Indoxyl sulfate was associated with incident symptomatic PAD but not with MACE or all-cause mortality, suggesting that indoxyl sulfate toxicity may be unique to PAD among hemodialysis patients.

scholarly journals Cholesterol Efflux Capacity Associates with the Ankle-Brachial Index but Not All-Cause Mortality in Patients with Peripheral Artery Disease

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1407
Author(s):  
Robert K. Clemens ◽  
Monika Hunjadi ◽  
Andreas Ritsch ◽  
Lucia Rohrer ◽  
Thomas O. Meier ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Cholesterol Efflux ◽  
Ankle Brachial Index ◽  
Mortality Rates ◽  
High Density Lipoproteins ◽  
Peripheral Artery ◽  
Cholesterol Efflux Capacity ◽  
Hdl Function ◽  
All Cause Mortality ◽  
Artery Disease

Background: Cholesterol efflux is an important mechanism by which high-density lipoproteins (HDLs) protect against cardiovascular disease. As peripheral artery disease (PAD) is associated with high mortality rates, mainly due to cardiovascular causes, we investigated whether cholesterol efflux capacity (CEC) of apolipoprotein B (apoB)-depleted plasma, a widely used surrogate of HDL function, may serve as a predictive marker for mortality in this patient population. Methods: In this prospective single-center study (median follow-up time: 9.3 years), apoB-containing lipoproteins were precipitated from plasma of 95 patients with PAD and incubated with J744-macrophages, which were loaded with radiolabeled cholesterol. CEC was defined as the fractional radiolabel released during 4 h of incubation. Results: Baseline CEC was lower in PAD patients that currently smoked (p = 0.015) and had a history of myocardial infarction (p = 0.011). Moreover, CEC showed a significant correlation with HDL-cholesterol (p = 0.003) and apolipoprotein A-I levels (p = 0.001) as well as the ankle-brachial index (ABI, p = 0.018). However, CEC did not differ between survivors and non-survivors. Neither revealed Kaplan–Meier and Cox regression analyses any significant association of CEC with all-cause mortality rates. Conclusion: Taken together, CEC is associated with ABI but does not predict all-cause mortality in patients with PAD.

Abstract MP14: Proteinuria is Associated With a Greater Risk of Lower Limb Amputation in Patients With Peripheral Artery Disease

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Jung-Im Shin ◽  
Morgan Grams ◽  
Josef Coresh ◽  
Alex Chang ◽  
Kunihiro Matsushita
Keyword(s):  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Antiplatelet Drug ◽  
Peripheral Artery ◽  
Increased Risk ◽  
Artery Disease

Introduction: Proteinuria is shown to be associated with increased risk of peripheral artery disease (PAD). However, its association with the risk of lower limb amputation in patients with PAD is unknown. Hypothesis: We hypothesized that proteinuria is associated with the risk of amputation in patients with PAD in a graded fashion. Methods: We identified 3,388 PAD patients with data on urine dipstick proteinuria within two years prior to PAD diagnosis between 1997 and 2017 in the Geisinger Health System (mean age 69.7 years, 44.8% female, 97.4% non-Hispanic White, 57.8% diabetic). We quantified the association of proteinuria with the risk of amputation using Cox proportional hazards models, adjusting for demographics, calendar year, estimated glomerular filtration rate, HbA1c, comorbidities including diabetic retinopathy/neuropathy, and medication use (antiplatelet drug, statin, and renin-angiotensin system inhibitor). Results: There were 55.2% with negative dipstick proteinuria, 11.1% trace, 14.1% with 1+, and 19.5% with ≥2+. A total of 245 patients underwent amputations over a median follow-up of 3.4 years. Incidence rate of amputation was 1.15 per 100 person-years for dipstick negative, 1.47 for trace, 2.11 for 1+, and 3.78 for ≥2+. This dose-response relationship remained similar even after accounting for potential confounders (p-trend=0.015), with particularly evident association for ≥2+ of dipstick (an adjusted hazard ratio of 1.52 [95% confidence interval: 1.08-2.17, p=0.017) (Figure). When we added proteinuria to other covariates, the risk discrimination slightly improved (Δc-statistic 0.007 [0.001-0.014]). Conclusions: Higher proteinuria was associated with a greater risk of lower limb amputation among patients with newly diagnosed PAD. Our results suggest the importance of considering proteinuria in risk assessment of limb loss in PAD patients.

scholarly journals Association between Peripheral Artery Disease and Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome: Findings from the Gulf COAST Registry

2019 ◽  
Vol 28 (5) ◽  
pp. 410-417 ◽  
Author(s):  
Ibrahim Al-Zakwani ◽  
Ekram Al Siyabi ◽  
Najib Alrawahi ◽  
Arif Al-Mulla ◽  
Abdullah Alnaeemi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Cardiovascular Events ◽  
Arabian Gulf ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
Vascular Insufficiency ◽  
All Cause Mortality ◽  
Artery Disease

Objective: To evaluate the association between peripheral artery disease (PAD) and major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) in the Arabian Gulf. Methods: Data from 4,044 consecutive patients diagnosed with ACS admitted to 29 hospitals in four Arabian Gulf countries from January 2012 to January 2013 were analyzed. PAD was defined as any of the following: claudication, amputation for arterial vascular insufficiency, vascular reconstruction, bypass surgery, or percutaneous intervention in the extremities, documented aortic aneurysm or an ankle brachial index of <0.8 in any of the legs. MACE included stroke/transient ischemic attack (TIA), myocardial infarction (MI), all-cause mortality, and readmissions for cardiac reasons diagnosed between hospital admission and at 1-year post discharge. Analyses were performed using univariate and multivariate statistical techniques. Results: The overall mean age of the cohort was 60 ± 13 years and 66% (n = 2,686) were males. A total of 3.3% (n = 132) of the patients had PAD. Patients with PAD were more likely to be associated with smoking, prior MI, hypertension, diabetes mellitus, and stroke/TIA. At the 1-year follow-up, patients with PAD were significantly more likely to have MACE (adjusted OR [aOR], 2.07; 95% confidence interval [CI]: 1.41–3.06; p< 0.001). The higher rates of events were also observed across all MACE components; stroke/TIA (aOR, 3.22; 95% CI: 1.80–5.75; p< 0.001), MI (aOR, 2.15; 95% CI: 1.29–3.59; p =0.003), all-cause mortality (aOR, 2.21; 95% CI: 1.33–3.69; p =0.002), and readmissions for cardiac reasons (aOR, 1.83; 95% CI: 1.24–2.70; p =0.003). Conclusions: PAD was significantly associated with MACE in ACS patients in the Arabian Gulf.

Peripheral artery disease is associated with frailty in chronic hemodialysis patients

Vascular ◽  
2018 ◽  
Vol 26 (4) ◽  
pp. 425-431 ◽  
Author(s):  
Michihiro Okuyama ◽  
Hidemi Takeuchi ◽  
Haruhito A Uchida ◽  
Yuki Kakio ◽  
Yuka Okuyama ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Peripheral Artery Disease ◽  
Odds Ratio ◽  
Ankle Brachial Index ◽  
Multivariate Logistic Regression Analysis ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Disease Group ◽  
Peripheral Artery ◽  
Artery Disease

Objectives The clinical condition of frailty is a common problem in the elderly population. However, the relationship between peripheral artery disease and frailty in hemodialysis patients remains unknown. The aim of this study was to identify the relationships between peripheral artery disease and frailty in Japanese chronic hemodialysis patients. Methods A total of 362 chronic hemodialysis patients who regularly visited six institutions were enrolled. To evaluate frailty, the modified Fried’s frailty phenotype adjusted for Japanese were used. Peripheral artery disease was defined as ankle-brachial index <0.9. Results Of 362 patients, 62 patients (17.1%) were categorized as peripheral artery disease group and 300 patients (82.9%) as Non-peripheral artery disease group. The prevalence of frailty in the peripheral artery disease group was significantly higher than in the Non-peripheral artery disease group (34% vs. 18%, P = 0.0103). Non-shunt side grip strength was significantly stronger in the Non-peripheral artery disease group (23.6 kg vs. 17.0 kg, P < 0.0001). Thigh circumferences were also significantly larger in the Non-peripheral artery disease group (41.7 cm vs. 39.7 cm, P = 0.0054). A multivariate logistic regression analysis demonstrated that the factors independently associated with peripheral artery disease were as follows: frailty (odds ratio = 2.06, 95% confidence interval 1.09–3.89) and myocardial infarction (odds ratio = 3.74, 95% confidence interval 2.05–6.83). Conclusions It is concluded that peripheral artery disease is closely associated with frailty in hemodialysis patients.

scholarly journals Valvular calcification and risk of peripheral artery disease: the Multi-Ethnic Study of Atherosclerosis (MESA)

2019 ◽  
Vol 21 (10) ◽  
pp. 1152-1159 ◽  
Author(s):  
Parveen K Garg ◽  
Petra Buzkova ◽  
Zahra Meyghani ◽  
Matthew J Budoff ◽  
Joao Lima ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Cardiac Computed Tomography ◽  
Ankle Brachial Index ◽  
Cox Proportional Hazards ◽  
Peripheral Artery ◽  
Ethnic Study ◽  
Valvular Calcification ◽  
Increased Risk ◽  
Artery Disease

Abstract Aims The detection of cardiac valvular calcification on routine imaging may provide an opportunity to identify individuals at increased risk for peripheral artery disease (PAD). We investigated the associations of aortic valvular calcification (AVC) and mitral annular calcification (MAC) with risk of developing clinical PAD or a low ankle–brachial index (ABI). Methods and results AVC and MAC were measured on cardiac computed tomography in 6778 Multi-Ethnic Study of Atherosclerosis participants without baseline PAD between 2000 and 2002. Clinical PAD was ascertained through 2015. Incident low ABI, defined as ABI &lt;0.9 and decline of ≥0.15, was assessed among 5762 individuals who had an ABI &gt;0.9 at baseline and at least one follow-up ABI measurement 3–10 years later. Adjusted Cox proportional hazards and Poisson regression modelling were used to determine the association of valvular calcification with clinical PAD and low ABI, respectively. There were 117 clinical PAD and 198 low ABI events that occurred over a median follow-up of 14 years and 9.2 years, respectively. The presence of MAC was associated with an increased risk of clinical PAD [hazard ratio 1.79; 95% confidence interval (CI) 1.04–3.05] but not a low ABI (rate ratio 1.28; 95% CI 0.75–2.19). No significant associations were noted for the presence of AVC and risk of either clinical PAD. Conclusion MAC is associated with an increased risk of developing clinical PAD. Future studies are needed to corroborate our findings and better understand whether MAC holds any predictive value as a risk marker for PAD.

Abstract P144: One-year Change In Walking Performance And Mobility Loss In People With Peripheral Artery Disease: The Walking And Leg Circulation Study (walcs)

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Michael M Hammond ◽  
Mary M McDermott ◽  
Lu Tian ◽  
Dongxue Zhang ◽  
Lihui Zhao
Keyword(s):  
Peripheral Artery Disease ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Peripheral Artery ◽  
Cox Proportional Hazards Models ◽  
Walking Performance ◽  
Artery Disease ◽  
One Year ◽  
Minute Walk

Introduction: Peripheral artery disease (PAD) affects 10-15% of people age 65 and older, and the prevalence is expected to rise as the population ages. People with PAD have greater functional impairment and faster decline in walking performance than people without PAD. Objectives: To determine the association between 1-year change in walking performance and mobility loss. We hypothesized that greater declines in walking performance over one year would be associated with higher rates of mobility loss. Methods: Participants underwent measurement of 6-minute walk and 4-meter walking velocity at baseline, and returned yearly for repeat measurement of walking performance and assessment of mobility. Participants were categorized into tertiles based on their 1-year change in walking performance (Tertile 1: greatest decline). Mobility loss was defined as becoming newly unable to walk one-quarter mile or walk up and down 1 flight of stairs without assistance after the 1-year follow-up. We used Cox proportional hazards models to examine the association between 1-year change in walking performance and mobility loss, adjusting for potential confounders. Results: 907 participants with PAD (mean age 71 +/- 9 years, 40% female, 23% black) were included. Median follow-up time was 38 months. Participants in Tertile 1 were older (mean 73 ± 9 years compared to 71 ± 9 in Tertile 2, and 70 ± 9 in Tertile 3; p=0.0004), had lower ABI (p=0.001), and included a higher prevalence of female (42% vs. 40% in Tertile 2, and 37% in Tertile 3; p=0.36). Participants with greater decline in 6-minute walk at 1-year follow-up had higher rates of mobility loss than participants with less decline. No significant associations of change in 4-meter walking speed and mobility loss were observed (Table). Conclusion: Among people with PAD, greater 1-year declines in six-minute walk distance are associated with higher rates of mobility loss. Further study is needed to determine whether interventions that prevent decline in six-minute walk can also prevent mobility loss.

scholarly journals One‐Year Change in Walking Performance and Subsequent Mobility Loss and Mortality Rates in Peripheral Artery Disease: Longitudinal Data From the WALCS

2021 ◽  
Author(s):  
Michael M. Hammond ◽  
Lu Tian ◽  
Lihui Zhao ◽  
Dongxue Zhang ◽  
Mary M. McDermott
Keyword(s):  
Peripheral Artery Disease ◽  
Proportional Hazards ◽  
Functional Performance ◽  
Performance Measure ◽  
Cox Proportional Hazards ◽  
Peripheral Artery ◽  
Cox Proportional Hazards Models ◽  
Walking Velocity ◽  
Artery Disease ◽  
Minute Walk

Background Associations of 1‐year change in functional performance measures with subsequent mobility loss and mortality in people with lower extremity peripheral artery disease are unknown. Methods and Results Six‐minute walk and 4‐meter walking velocity (usual and fastest pace) were measured at baseline and 1 year later in 612 people with peripheral artery disease (mean age 71±9 years, 37% women). Participants were categorized into tertiles, based on 1‐year changes in walking measures. Cox proportional hazards models were used to examine associations between 1‐year change in each walking measure and subsequent mobility loss and mortality, respectively, adjusting for potential confounders. Compared with the best tertile, the worst tertile (ie, greatest decline) in 1‐year change in each performance measure was associated with higher rates of mobility loss: 6‐minute walk (Tertile 1 [T1] cumulative incidence rate [IR], 72/160; Tertile 3 [T3] IR, 47/160; hazard ratio [HR], 2.35; 95% CI, 1.47–3.74), usual‐paced 4‐meter walking velocity (T1 IR, 54/162; T3 IR, 57/162; HR, 2.21; 95% CI, 1.41–3.47), and fast‐paced 4‐meter walking velocity (T1 IR, 61/162; T3 IR, 58/162; HR, 1.81; 95% CI, 1.16–2.84). Compared with the best tertile, the worst tertiles in 1‐year change in 6‐minute walk (T1 IR, 66/163; T3 IR, 54/163; HR, 1.61; 95% CI, 1.07–2.43) and fast‐paced 4‐meter walking velocity (T1 IR, 63/166; T3 IR, 44/166; HR, 1.75; 95% CI, 1.16, 2.64) were associated with higher mortality. Conclusions In people with peripheral artery disease, greater 1‐year decline in 6‐minute walk or 4‐meter walking velocity may help identify people with peripheral artery disease at highest risk for mobility loss and mortality.

Far-infrared therapy improves ankle brachial index in hemodialysis patients with peripheral artery disease

2018 ◽  
Vol 34 (3) ◽  
pp. 435-441
Author(s):  
Chun-Fan Chen ◽  
Fu-An Chen ◽  
Ann Charis Tan ◽  
Tsung-Lun Lee ◽  
Chia-Hao Chan ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Far Infrared ◽  
Hemodialysis Patients ◽  
Peripheral Artery ◽  
Artery Disease
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