Association of peripheral arterial disease with all-cause and cardiovascular mortality in hemodialysis patients: a meta-analysis

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.

Prevalence, clinical characteristics, and predictors of peripheral arterial disease in hemodialysis patients: a cross-sectional study

“…Lower Kt/V values were observed among patients in the PAD group, which is consistent with the findings from other studies [11, 25]. These findings might help explain why some uremic toxins that are not removed by dialysis, for example, dimethylarginine, accumulates, damages endothelial cells, and causes atherogenesis [19].…”

“…Intermittent claudication is the classic and most striking symptom associated with PAD, and it is relatively rare in the general population and in patients on HD [5, 19]. Therefore, intermittent claudication alone is not a reliable criterion for a diagnosis of PAD [6].…”

“…In studies that used ABI < 0.9 as a criterion for PAD diagnosis in patients on HD, PAD prevalence was slightly higher and it reached 37% [6]. Because ABIs < 0.9 are relevant for a diagnosis of PAD, they are an important prognostic factor associated with cardiovascular disease and mortality in patients on HD [11, 16, 19].…”

The prognosis of kidney transplant recipients with aorto‐iliac calcification: a systematic review and meta‐analysis

“…Second, vascular complications like steal syndrome or trash foot may be a threat to the vascular challenging transplant candidate . As a third reason, patients with VC are considered to have a limited life expectancy due to cardiovascular comorbidities, leading to a high perioperative mortality risk and limiting 5‐year patient survival to 35% . Due to organ shortage, it might not be ethical to perform a deceased donor KTx in patients with such a limited life expectancy.…”

Positive Association of Serum Adipocyte Fatty Acid Binding Protein Level With Peripheral Artery Disease in Hemodialysis Patients

“…It is important to diagnose PAD in HD patients because the prevalence of PAD in such patients (around 26%) was found to be much higher than in the general population (3–10%) . In addition, a recent meta‐analysis revealed that PAD was positively correlated to cardiovascular disease and all‐cause mortality in HD patients .…”