Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures

Abstract

Otsubo et al. [1] in this issue of International Urology and Nephrology report that peripheral arterial disease (PAD) is an independent predictor of mortality in hemodialysis patients. In univariate analysis, the presence of PAD was associated with a 67% increase in long-term mortality risk in patients undergoing maintenance hemodialysis compared with the absence of PAD (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.18–2.28; P = 0.004) [1]. The relation between PAD and mortality persisted even after adjustment for age, gender, duration of dialysis, diabetes mellitus and smoking (OR, 1.575; 95% CI, 1.038–2.381; P = 0.033) [1]. These findings support the results of earlier studies showing that PAD is common in dialysis patients and that it is associated with increased cardiovascular morbidity and mortality rates in this population [2–4]. This Editorial discusses some additional aspects that may be of interest. There is a strong two-way correlation between impaired renal function and PAD. A recent comprehensive review demonstrated that 27–36% of patients with PAD also have concomitant impaired renal function [5]. The presence of impaired renal function in these individuals is associated not only with higher morbidity and mortality rates but also with the occurrence of cardiovascular events (stroke, myocardial infarction, and cardiovascular death) [5]. Furthermore, impaired renal function negatively affects survival, limb salvage and graft patency rates when these individuals undergo lower extremity revascularization procedures [5]. Conversely, patients on chronic dialysis have high atherosclerosis and arteriosclerosis rates [6]; the increased arterial stiffness is responsible for the high prevalence of carotid artery stenosis, myocardial infarction, PAD, and stroke in this population [6]. PAD is an atherosclerotic occlusive disease with/without vascular calcifications in the intima of lower extremity arteries [7–9]. The symptoms of PAD include intermittent claudication, which progresses to ischemic leg pain, critical limb ischemia, and finally, tissue necrosis requiring amputation. The prevalence of PAD is high among patients K. I. Paraskevas (&) A. Nikolaou Department of Vascular Surgery, ‘‘Red Cross’’ Hospital, 24, Al. Papagou street, Athens, Greece e-mail: paraskevask@hotmail.com