Abstract
BackgroundAsymptomatic peripheral artery disease (PAD) increases the risk of mortality in non-hemodialysis patients. However, the association between asymptomatic PAD and mortality rate remains unclear in patients on hemodialysis.MethodsThis retrospective cohort study aimed to assess the prognostic significance of asymptomatic PAD in a population of 310 hemodialysis patients. Patients with an ankle–brachial index of < 1.00, or > 1.40 with a toe–brachial index of < 0.70, were diagnosed as having PAD. The San Diego Claudication Questionnaire was used to characterize leg symptoms in patients with PAD, and asymptomatic PAD was defined as the absence of symptoms in the legs or buttocks while walking. The mortality risk of asymptomatic PAD was assessed using the Cox proportional hazard model.ResultsThe rate of PAD was 28.1%. Among 87 patients, those with PAD, 66.7% were asymptomatic. Fifty-eight patients died during a mean follow-up of 38.9 months. Multivariate analysis revealed hazard ratios of 1.963 (95% confidence interval (CI), 1.012 to 3.740; P = 0.046) and 3.237 (95% CI, 1.402 to 7.020; P = 0.007) in patients with asymptomatic PAD and symptomatic PAD, respectively, compared to patients without PAD. No significant difference was observed between patients with asymptomatic PAD and symptomatic PAD in terms of survival.ConclusionsHemodialysis patients with asymptomatic PAD have an elevated mortality risk compared to patients without PAD, with no significant difference compared to patients with symptomatic PAD.
Highlights
Asymptomatic peripheral artery disease (PAD) increases the risk of mortality in non-hemodialysis patients
Significant differences were observed between non-PAD and total PAD groups in age, cause of end-stage renal disease (ESRD), prevalence of diabetes, coronary artery disease, cerebrovascular disease, spinal stenosis, use of beta-blockers, antiplatelet agents, and anticoagulant agents, smoking status, diastolic blood pressure, pulse pressure, ankle–brachial index (ABI), toe–brachial index (TBI), and levels of creatinine, albumin, high-density lipoprotein cholesterol (HDL-C), and triglycerides
A significant difference in dialysis vintage and ABI was observed between asymptomatic PAD and symptomatic PAD groups
Summary
Asymptomatic peripheral artery disease (PAD) increases the risk of mortality in non-hemodialysis patients. The association between asymptomatic PAD and mortality rate remains unclear in patients on hemodialysis. Peripheral artery disease (PAD) is associated with an increased risk of all-cause and atherosclerotic mortality [1]. In 2009, Diehm et al [6] reported that the mortality risk among asymptomatic PAD patients did not differ significantly from that among symptomatic PAD patients in communitydwelling adults. One reason for the high proportion of asymptomatic PAD among HD patients is that habitual physical activity levels are reportedly low in these patients [11], and given that HD patients often have peripheral neuropathy due to a high prevalence of diabetes [12], their leg symptoms such as pain and numbness are masked
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