In the Journals

Peripheral artery disease more common in patients with late-stage CKD

Peripheral artery disease is more common in patients with late-stage chronic kidney disease and may lead to adverse events, according to results of a retrospective cohort study published in the American Journal of Kidney Diseases.

Researchers analyzed patient-level data from several administrative health service databases to compare the prevalence of peripheral artery disease (PAD) with or without CKD. Outcomes included all-cause mortality, lower limb complications and cardiovascular events.

“The 5-year cumulative incidence of lower limb complications was compared in each kidney function group stratified by the presence of PAD at baseline using the cumulative incidence function method in the presence of competing events,” Mathieu Bourrier, MD, of the Max Rady College of Medicine at the University of Manitoba in Winnipeg, Canada, and colleagues wrote.

In total, the cohort included 453,573 adult patients with at least one serum creatinine measurement from January 2007 to October 2014. Of the patients, 20,600 (4.5%) had a PAD diagnosis with greater burden of kidney disease and were older than the non-PAD group (mean age 69 vs 50.7). Of the patients with PAD, 6,170 (30%) had CKD G3 to G5 and 644 (3.1%) had CKD G5D.

Patients with CKD G5D had the highest absolute risk rate for lower limb complications (40.5 per 1,000 patient-years), cardiovascular events (114.9 per 1,000 patient-years) and all-cause mortality (141.3 per 1,000 patient-years).

Researchers wrote these results suggest patients with PAD who receive dialysis should be considered at extreme risk for these adverse outcomes and trials for screening and treatment strategies for these complications should be studied.

“PAD was common in those with reduced kidney function and associated with multiple serious adverse outcomes,” the researchers wrote. “Although the relative impact of PAS was lower in the presence of coexisting CKD G3-G5 or CKD G5D, both groups of patients had markedly high crude rates of all adverse events.”

Bourrier and colleagues “uniquely demonstrated the joint associations of PAD and reduced kidney function,” Manabu Hishida, MD, of the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, wrote in an accompanying editorial.

Hishida added that according to the U.S. Renal Data System, the percentage of patients with PAD and CKD is higher than those with myocardial infarction and stroke.

“This growing body of evidence suggests that patient management and prognosis could be improved if health care providers, including nephrologists and cardiologists, pay closer attention to leg health in patients with CKD, especially those treated by dialysis,” Hishida and colleagues wrote. – by Erin T. Welsh

Disclosures: Bourrier reports no relevant financial disclosures. Please see the study and editorial for all other authors’ relevant financial disclosures.

Peripheral artery disease is more common in patients with late-stage chronic kidney disease and may lead to adverse events, according to results of a retrospective cohort study published in the American Journal of Kidney Diseases.

Researchers analyzed patient-level data from several administrative health service databases to compare the prevalence of peripheral artery disease (PAD) with or without CKD. Outcomes included all-cause mortality, lower limb complications and cardiovascular events.

“The 5-year cumulative incidence of lower limb complications was compared in each kidney function group stratified by the presence of PAD at baseline using the cumulative incidence function method in the presence of competing events,” Mathieu Bourrier, MD, of the Max Rady College of Medicine at the University of Manitoba in Winnipeg, Canada, and colleagues wrote.

In total, the cohort included 453,573 adult patients with at least one serum creatinine measurement from January 2007 to October 2014. Of the patients, 20,600 (4.5%) had a PAD diagnosis with greater burden of kidney disease and were older than the non-PAD group (mean age 69 vs 50.7). Of the patients with PAD, 6,170 (30%) had CKD G3 to G5 and 644 (3.1%) had CKD G5D.

Patients with CKD G5D had the highest absolute risk rate for lower limb complications (40.5 per 1,000 patient-years), cardiovascular events (114.9 per 1,000 patient-years) and all-cause mortality (141.3 per 1,000 patient-years).

Researchers wrote these results suggest patients with PAD who receive dialysis should be considered at extreme risk for these adverse outcomes and trials for screening and treatment strategies for these complications should be studied.

“PAD was common in those with reduced kidney function and associated with multiple serious adverse outcomes,” the researchers wrote. “Although the relative impact of PAS was lower in the presence of coexisting CKD G3-G5 or CKD G5D, both groups of patients had markedly high crude rates of all adverse events.”

Bourrier and colleagues “uniquely demonstrated the joint associations of PAD and reduced kidney function,” Manabu Hishida, MD, of the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, wrote in an accompanying editorial.

Hishida added that according to the U.S. Renal Data System, the percentage of patients with PAD and CKD is higher than those with myocardial infarction and stroke.

“This growing body of evidence suggests that patient management and prognosis could be improved if health care providers, including nephrologists and cardiologists, pay closer attention to leg health in patients with CKD, especially those treated by dialysis,” Hishida and colleagues wrote. – by Erin T. Welsh

Disclosures: Bourrier reports no relevant financial disclosures. Please see the study and editorial for all other authors’ relevant financial disclosures.