Peripheral artery disease in chronic kidney disease
- Ann M O'Hare, MD
Ann M O'Hare, MD
- Associate Professor of Medicine
- University of Washington School of Medicine
- Section Editors
- Gary C Curhan, MD, ScD
Gary C Curhan, MD, ScD
- Section Editor — Chronic Kidney Disease
- Editor-in-Chief emeritus
- Harvard Medical School
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Science Center
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
It is increasingly recognized that chronic kidney disease (CKD) is an independent risk factor for the development of generalized atherosclerosis and coronary artery disease, and is associated with a worse prognosis following cardiovascular events. Most patients with CKD have only moderate reductions in eGFR and are at a much higher risk of morbidity and death related to cardiovascular disease than of eventually requiring renal replacement therapy. (See "Chronic kidney disease and coronary heart disease".)
Lower extremity peripheral artery disease (PAD) is a significant clinical issue among patients with CKD. Traditionally, most studies of the epidemiology of cardiovascular disease did not report subgroup analyses among patients with CKD [1-5], and epidemiologic studies of PAD have generally not included CKD as a potential risk factor [6-10]. However, a growing number of studies have now described an association between PAD and CKD.
This topic will focus on aspects of the epidemiology, diagnosis, and treatment of PAD relevant to individuals with CKD. CKD will refer to individuals with decreased kidney function, excluding dialysis patients and kidney transplant recipients. A review of this issue among patients with end-stage renal disease, and more detailed management recommendations for PAD in the general population are presented separately. (See "Lower extremity peripheral artery disease in end-stage renal disease" and "Noninvasive diagnosis of arterial disease" and "Management of claudication" and "Clinical features and diagnosis of lower extremity peripheral artery disease" and "Surgical management of claudication" and "Treatment of chronic lower extremity critical limb ischemia".)
The 2005 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on peripheral artery disease (PAD), which were produced in collaboration with major vascular medicine, vascular surgery, and interventional radiology societies do not specifically identify chronic kidney disease (CKD) as being a risk factor for PAD . The Inter-Society Consensus for the Management of Peripheral Artery Disease (TASC-II) notes the association of renal insufficiency and PAD, suggesting it may be causal, but provides little supporting evidence.
Prevalence — PAD appears to be more prevalent among patients with CKD than in the general population. To some extent, this may reflect the older age and higher prevalence of known risk factors for PAD such as dyslipidemias, diabetes, hypertension, and other forms of vascular disease among those with CKD; however, even after adjustment for these potential confounders, CKD is independently associated with an increased prevalence of PAD, and with the future risk for developing clinically significant PAD [12-14]. Risk factors for PAD are reviewed elsewhere.
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