Abstract
Introduction: Peripheral artery disease (PAD) increases the risk of various adverse outcomes such as other cardiovascular diseases, lower-extremity amputation, and infection. However, its impact on kidney outcomes is yet to be characterized. Hypothesis: Both symptomatic and asymptomatic PAD will be associated with kidney outcomes. Methods: Using data from the ARIC study (1987-1989), we categorized 13,864 participants with estimated glomerular filtration rate (eGFR) >15 mL/min (mean age 54 [SD 6 years]) into symptomatic PAD (clinical history or intermittent claudication); asymptomatic PAD (ankle-brachial index [ABI] ≤0.90 but not symptomatic PAD); and ABI categories of 0.91-1.00, 1.01-1.10, 1.11-1.20 (reference), 1.21-1.30, and >1.30. Incident end-stage kidney disease (ESKD) was defined by the need for renal replacement therapy or death due to chronic kidney disease (CKD), and incident CKD was defined by ≥25% decline in eGFR to <60 mL/min or hospitalizations with CKD diagnosis among those with ≥eGFR 60 at baseline. We ran multivariable Cox models. Results: There were 580 ESKD cases and 4,602 CKD cases over ~30 years of follow-up. Both symptomatic PAD and asymptomatic PAD were significantly associated with incident ESKD with hazard ratios (HR) of 2.21 (95%CI 1.16-4.22) and 1.59 (1.07-2.36), respectively, after adjusting for potential confounders such as other cardiovascular diseases and diabetes (Table). The corresponding HRs for incident CKD were 1.43 (1.05-1.95) and 1.60 (1.35-1.90). Borderline low ABI 0.91-1.00 showed an elevated risk of kidney outcomes in demographically- adjusted Model 1. Conclusions: Symptomatic PAD and asymptomatic PAD were independently associated with a higher long-term risk of ESKD and CKD. These results further support the close link between atherosclerosis and kidney prognosis and highlight the need for kidney monitoring in persons with PAD regardless of leg symptoms.
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