Abstract
BackgroundRecent studies have shown an association between peripheral arterial disease (PAD) and increased risk of mortality in hemodialysis (HD) patients; however, the estimates vary widely and are inconsistent. It is necessary to elucidate the degree of mortality risk for PAD patients in HD population.MethodsPubMed, EMBASE, Web of Science and Cochrane Library (from inception to September 4th, 2016) were systematically searched for cohort studies assessing the association between PAD and mortality in HD patients. We calculated the pooled risk ratios (RRs) with 95% confidence intervals (CI) of all-cause and cardiovascular (CV) mortality using random effects models. Subgroup analyses were conducted to explore the source of heterogeneity.ResultsThe search identified 2,973 potentially eligible records and 10 studies (n = 32,864) were included. Our meta-analysis revealed that PAD significantly increased the risk of all-cause mortality (RR 2.15, 95 % CI 1.67–2.77, n = 32,864) and CV mortality (RR 2.99, 95 % CI 1.66-5.38, n = 31,794) in HD patients after multivariate adjustment. Subgroup analyses showed the study design and follow-up time might be two sources of heterogeneity.ConclusionPAD may be a prognostic marker of all-cause and CV mortality in HD patients. More attention should be paid to diagnosis and management of PAD in HD patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0397-1) contains supplementary material, which is available to authorized users.
Highlights
Recent studies have shown an association between peripheral arterial disease (PAD) and increased risk of mortality in hemodialysis (HD) patients; the estimates vary widely and are inconsistent
We considered the patients with Ankle-brachial blood pressure index (ABI) < 0.9 as having PAD, (4) studies had analysis for association between patients with PAD and the risk of all-cause and/or CV mortality on follow-up, and quantitative data evaluating the association was possible to be extracted, (5) there was no language restriction
Statistical analyses The studies included in our meta-analysis reported different effect measure, and we combined it as Risk ratio (RR) throughout this article
Summary
Recent studies have shown an association between peripheral arterial disease (PAD) and increased risk of mortality in hemodialysis (HD) patients; the estimates vary widely and are inconsistent. It is necessary to elucidate the degree of mortality risk for PAD patients in HD population. More than 2 million people are suffering from end-stage renal disease (ESRD) worldwide [1] and growing numbers of patients are receiving hemodialysis (HD) as a choice for renal replacement therapy [2]. The mortality of HD patients was high. A review reported that the annual crude death rate was in the range of 9.0%–10.2% for dialysis populations in Japan [2]. Yan et al [3] followed up 385,074 HD patients and reported that the one-year mortality was 19.8% and the five-year mortality was 43.0%. Peripheral arterial disease (PAD) is a systemic vascular disorder
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