Prevalence, Predictors, and Impact of Peripheral Arterial Disease in Hemodialysis Patients

Thani, Hassan Al; El‐Menyar, Ayman; Hussein, Ahmed; Sadek, Ahmed; Sharaf, Ahmed; Singh, Rajvir; Koshy, Valsa; Suwaidi, Jassim Al

doi:10.1177/0003319711436078

Cited by 13 publications

(18 citation statements)

References 27 publications

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“…[24] Several recent studies have shown an association between an abnormal ABI and overall and CV mortality. [4525] As the results of our observation period (maximum of 7 years) showed, PAD was an independent risk factor for all-cause and CV mortality.…”

Section: Discussionmentioning

confidence: 77%

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Association of adiponectin with peripheral arterial disease and mortality in nondiabetic hemodialysis patients: Long-term follow-up data of 7 years

Zhou

Zhang

et al. 2016

J Res Med Sci

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Background:The relationships between adiponectin and clinical outcomes in hemodialysis (HD) patients remain highly controversial. Meanwhile, the association between adiponectin and the peripheral artery disease (PAD) has not been well studied in HD patients without diabetic mellitus.Materials and Methods:The ankle-brachial index was measured in HD patients. Adiponectin levels in 105 HD patients were measured by Enzyme-Linked Immunosorbant Assay.Results:105 HD patients were enrolled; 14 (13%) patients had PAD. Using receiver-operating-characteristic (ROC) curve analysis for PAD, adiponectin (area under the curve [AUC] 0.935, 95% confidence interval [CI]: 0.848–0.981, P < 0.001) showed significantly positive predictive value. During follow-up (mean 63 ± 30 months), 34 deaths (32%) occurred. Kaplan–Meier analysis found those patients lower median adiponectin had a significantly poor outcome (P < 0.05), and Cox analysis further confirmed that adiponectin was an independent predictor of overall mortality (hazard ratio [HR], 0.832, 95% CI: 0.696–0.995, P < 0.05). The ROC curve of overall mortality showed that the AUC of adiponectin was 0.719 (95% CI: 0.586–0.813, P < 0.05). In HD patients with PAD, the univariate analysis showed that adiponectin (HR, 0.649, 95% CI: 0.527–0.800, P < 0.001) was also associated with overall mortality.Conclusion:Decreasing levels of adiponectin were associated with a significant increase in the risk of PAD in HD patients without diabetic mellitus. Furthermore, as the results of our observation period (maximum of 7 years) showed, adiponectin was a predictor of all-cause mortality in HD patients.

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Section: Discussionmentioning

confidence: 77%

“…[3] Recent data suggest that PAD is a strong predictor for overall mortality in hemodialysis (HD) patients. [45]…”

Section: Introductionmentioning

confidence: 99%

Association of adiponectin with peripheral arterial disease and mortality in nondiabetic hemodialysis patients: Long-term follow-up data of 7 years

Zhou

Zhang

et al. 2016

J Res Med Sci

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“…Interestingly, a recent study advocated a higher incidence of risk factors (PAD and peripheral neuropathy) for FU among HD patients [13]. In Qatar, an earlier report from our center identified a high incidence of PAD in HD patients [14]. However, there is a lack of information that describes the risk factors and prognostic implications of FU among HD patients in the Arab Middle East.…”

Section: Introductionmentioning

confidence: 99%

Implications of Foot Ulceration in Hemodialysis Patients: A 5-Year Observational Study

Al-Thani

El‐Menyar

Koshy

et al. 2014

Journal of Diabetes Research

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Foot ulceration (FU) remains a serious concern for patients worldwide. We analyzed the incidence, risk factors, and outcome of FU in hemodialysis (HD) patients. A retrospective cohort study was conducted for 252 HD patients who were followed up for 5 years. Patients were categorized according to whether they developed FU or not. The FU group (17%) was older and had significantly higher incidence of nephropathy, retinopathy, peripheral (PAD), coronary artery disease (CAD), and diabetes mellitus (DM) as compared to no-FU group. FU group had higher frequency of major amputation (P = 0.001) and HD vascular access (P = 0.01). Patients with combined DM and PAD had a 10-fold increased risk of FU in comparison to those who had DM alone. Presence of PAD was the main independent predictor for development of FU in HD with an adjusted odd ratio (aOR) of 16.0 (95% CI: 4.41–62.18; P = 0.001). After adjusting for age, sex, and CAD, predictors for mortality were PAD (aOR 4.3), FU (aOR 3.6), and DM (aOR 2.6). FU is common in HD patients regardless of DM. However, the presence of PAD is significantly associated with more FU and mortality in HD. HD patients need intensive foot care and warrant progressive modification of vascular risk factors.

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“…Therefore, vascular disease prevention in these patients is important to reduce the incidence of cardiovascular events and the high morbidity and mortality [22]. Several recent studies have shown an association between an abnormal ABI and overall and cardiovascular mortality [3,4,23.] As shown in the results of our observation period (maximum of 6 years), PAD was an independent risk factor for all-cause and cardiovascular mortality.…”

Section: Discussionmentioning

confidence: 51%

“…Some experts have begun to pay attention to the importance of PAD and its biomarkers [2]. Recent data suggest that PAD is a strong predictor for overall mortality in hemodialysis (HD) patients [3,4]. Traditional risk factors alone do not explain the unacceptably high prevalence and incidence of CVD in ESRD patients [5].…”

Section: Introductionmentioning

confidence: 99%

Plasma Pentraxin 3 Is Closely Associated with Peripheral Arterial Disease in Hemodialysis Patients and Predicts Clinical Outcome: A 6-Year Follow-Up

et al. 2015

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Background: The aim of this study is to investigate the value of plasma PTX3 level for assessing peripheral artery disease (PAD) and clinical outcome in hemodialysis (HD) patients. Methods: The ankle-brachial index (ABI) was measured in HD patients. PTX3 levels in 116 HD patients were measured by ELISA. Results: Overall, 116 HD patients were enrolled; 21 (18%) patients had PAD. Using the ROC curve analysis for PAD, PTX3 (cut-off value 4.06 ng/ml, AUC 0.901, p < 0.0001) showed a significantly better positive predictive value than hsCRP (cut-off value 3.33 ng/ml, AUC 0.640, p < 0.05). During follow-up (mean 57 ± 26 months), 40 deaths (34%) occurred. Kaplan-Meier analysis found that those patients with elevated PTX3 had a significantly poor outcome (p < 0.0001), and Cox analysis further confirmed that PTX3 was an independent predictor of overall mortality (HR, 1.105, p = 0.03). For prediction of overall mortality, the AUC for PTX3 (cut-off value 3.22 ng/ml, AUC 0.690, p < 0.0001) was close to hsCRP (cut-off value 5.84 ng/ml, AUC 0.620, p < 0.001). Conclusions: For the prediction of PAD in HD patients, the diagnostic sensitivity and specificity of PTX3 were higher than those of hsCRP. Furthermore, PTX3 was also a predictor of all-cause mortality in HD patients. PTX3 may be considered a novel biomarker of inflammation in HD patients.

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Prevalence, Predictors, and Impact of Peripheral Arterial Disease in Hemodialysis Patients

Cited by 13 publications

References 27 publications

Association of adiponectin with peripheral arterial disease and mortality in nondiabetic hemodialysis patients: Long-term follow-up data of 7 years

Association of adiponectin with peripheral arterial disease and mortality in nondiabetic hemodialysis patients: Long-term follow-up data of 7 years

Implications of Foot Ulceration in Hemodialysis Patients: A 5-Year Observational Study

Plasma Pentraxin 3 Is Closely Associated with Peripheral Arterial Disease in Hemodialysis Patients and Predicts Clinical Outcome: A 6-Year Follow-Up

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