High Prevalence of Peripheral Arterial Disease in Persons With Renal Insufficiency

Author:

O’Hare Ann M.1,Glidden David V.1,Fox Caroline S.1,Hsu Chi-yuan1

Affiliation:

1. From the Division of Nephrology, VAMC San Francisco and University of California (A.M.O.), San Francisco, Calif; Department of Epidemiology and Biostatistics (D.V.G.), University of California, San Francisco, Calif; Framingham Heart Study (C.S.F.), National Heart, Lung, and Blood Institute, Framingham, Mass; and Division of Nephrology, University of California (C.H.), San Francisco, Calif.

Abstract

Background— Although renal insufficiency is a recognized risk factor for coronary artery disease, little is known about the epidemiology of lower-extremity peripheral arterial disease (PAD) in persons with renal insufficiency. Methods and Results— We examined the cross-sectional association of PAD, defined as an ankle-brachial index (ABI) <0.9, and renal insufficiency, defined as an estimated creatinine clearance (CRCL) <60 mL · min −1 · 1.73 m −2 , among 2229 eligible participants in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2000. An estimated 1.2±0.3 million persons ≥40 years old with CRCL <60 mL · min −1 · 1.73 m −2 (24%) have PAD defined as an ABI <0.9 (versus 3.7% of persons with CRCL ≥60 mL · min −1 · 1.73 m −2 ). The association of ABI <0.9 with renal insufficiency was independent of potential confounders such as age, diabetes, hypertension, coronary artery disease, stroke history, and hypercholesterolemia (OR 2.5, 95% CI 1.2 to 5.1, P =0.011, referent category ABI 1.0 to 1.3). Conclusions— Clinicians should be aware of the remarkably high prevalence of PAD among patients with renal insufficiency. In the clinical setting, accurate identification of patients with renal insufficiency combined with routine ABI measurement in this group would greatly enhance efforts to detect subclinical PAD.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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