Prevalence of Peripheral Arterial Disease among End Stage Renal Disease Patients

Abstract

Abstract Background Patients with End Stage Renal Disease are more susceptible to develop Peripheral Arterial Disease. so, screening is helpful for early diagnosis. Objectives The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD. Aim of Study The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD. Patients and Methods The study included 100 asymptomatic patients on regular hemodialysis and below 60 years old to be screened for presence of PAD. Patients who refused the test, above 60 years old, or diabetic have been excluded from the study. All selected patients have been subjected to complete history taking, full clinical examination including extremities examination, Lab workup including; CBC, liver function test, kidney function test, A1C level, lipid profile, Resting 12 lead ECG, Echocardiography to assess systolic function, valvular disease, and resting SWMA, and ABI assessment using the Doppler. Patients then were divided into two groups; control group who has negative PAD with ABI > 0.9 and study group who has PAD with ABI ≤ 0.9. Results It was found that the prevalence of PAD among ESRD patients is 26%. Regarding the laterality; 21% had bilateral PAD and the rest 5% had unilateral disease. The results showed that females had statistically significant higher risk of developing PAD that males. 55% of patients were females and the other 45% were males. 36.4% of females studied had positive ABI but only 13.3% of studied males found positive for PAD. The p value was 0.017. The study showed also that A1C level in patients who have no diabetes carries statistically significant results. The mean A1C level for the study group was 5.56 ± 0.70 and the control group was 4.92 ± 0.73. The p value was 0.000. The A1C level cut off value was > 5.3. This means that patients who have A1C > 5.3 should be paid more attention and be screened because they have higher risk to develop PAD. Conclusion Renal impairment is an important risk factor for developing PAD in absence of traditional risk factors such as DM, hypertension, or dyslipidemia. Prevalence of PAD was 26% in our study. ABI is a simple non-invasive modality of screening for PAD. Females are at higher risk to develop PAD than males by ∼ 2.7 fold. Although diabetes is absent, A1C level > 5.3 is significantly correlating with the risk of PAD.