Lower extremity peripheral artery disease in end-stage renal disease
- Ann M O'Hare, MD
Ann M O'Hare, MD
- Associate Professor of Medicine
- University of Washington School of Medicine
- Kirsten Johansen, MD
Kirsten Johansen, MD
- Professor of Medicine and Epidemiology
- University of California, San Francisco
- Section Editor
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
Among patients with end-stage renal disease (ESRD), peripheral artery disease (PAD) is common and is associated with substantial morbidity and mortality [1-12]. However, compared to other atherosclerotic diseases such as coronary and cerebrovascular disease, little is known concerning the epidemiology of lower extremity PAD in this population and limited information is available to guide treatment and preventive strategies.
Lower extremity PAD in patients undergoing maintenance dialysis will be reviewed here. PAD in patients with chronic kidney disease and general issues related to PAD in patients in the general population are discussed separately. (See "Peripheral artery disease in chronic kidney disease" and "Overview of lower extremity peripheral artery disease".)
Among patients with ESRD, estimates of the prevalence of PAD vary in part according to the specific population studied:
●In the United States, the overall prevalence of PAD among patients initiating dialysis is approximately 14 to 15 percent [13,14].
●Based on the HEMO study and the USRDS database, the prevalence of PAD is approximately 25 percent among chronic hemodialysis patients [15,16].
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- RISK FACTORS
- CLINICAL MANIFESTATIONS
- TREATMENT OF EARLY DISEASE
- Risk factor reduction
- Preventive foot care
- Approach to treatment
- TREATMENT OF LIMB-THREATENING ISCHEMIA
- Limb-sparing procedures
- - Surgical revascularization
- - Angioplasty
- - Spinal cord stimulation
- - Prostaglandins
- Conservative management
- Approach to treatment
- GENERAL PROGNOSIS
- SUMMARY AND RECOMMENDATIONS