Unique aspects of peripheral artery disease in patients with chronic kidney disease

Abstract

Peripheral artery disease (PAD) represents a major health care burden. Despite the advent of screening and interventional procedures, the long-term clinical outcomes remain suboptimal, especially in patients with chronic kidney disease (CKD). While CKD and PAD share common predisposing factors, emerging studies indicate that their co-existence is not merely an association; instead, CKD represents a strong, independent risk factor for PAD. These findings implicate CKD-specific mediators of PAD that remain incompletely understood. Moreover, there is a need to understand the mechanisms underlying poor outcomes after interventions for PAD in CKD. This review discusses unique clinical aspects of PAD in patients with CKD, including high prevalence and worse outcomes after vascular interventions and the influence of renal allograft transplantation. In doing so, it also highlights underappreciated aspects of PAD in patients with CKD, such as disparities in revascularization and higher peri-procedural mortality. While previous reviews have discussed general mechanisms of PAD pathogenesis, focusing on PAD in CKD, this review underscores a need to probe for CKD-specific pathogenic pathways that may unravel novel biomarkers and therapeutic targets in PAD and ultimately improve the risk stratification and management of patients with CKD and PAD.

Lipoprotein‐associated phospholipase A2 predicts lower limb ischemia in hemodialysis subjects

“…3 Regarding the traditional therapeutic options, renal subjects undergo fewer revascularization procedures, but experience increased perioperative complications and worse outcomes after interventions. 18 The identification of possible predictors and pathogenic determinants of PAD might allow a strict surveillance, an early diagnosis, and intervention of these highrisk subjects. In addition to the traditional risk factors, new markers are increasingly recognized to play an important role for cardiac and vascular disease.…”

“…PAD represents an highly prevalent and aggressive disease among patients with advanced renal failure: foot ulceration and amputation account up to 30% and 15%, respectively, among diabetic dialyzed patients, compared to 15% and 7% among diabetic non‐dialyzed‐ones and the post‐amputation mortality is about 16% among renal subjects in contrast to 6% in subjects with normal renal function . Regarding the traditional therapeutic options, renal subjects undergo fewer revascularization procedures, but experience increased perioperative complications and worse outcomes after interventions …”

“…In the uremic milieu, PAD quickly shows an aggressive behavior, with high prevalence of ulceration and amputation 17 ; in addition renal subjects undergo fewer revascularization procedures, but experience increased perioperative complications and worse outcomes after interventions. 18 The burden of this severe disease is due to a lot of traditional (diabetes, hypertension, smoke, hyperlipemia) and uremia-related (inflammation, vascular calcifications) risk factors, but probably also to a lot of other partially unknown burden of vascular toxins. As a consequence, understanding the relationship between PAD and its etiological factors might allow a strict surveillance and probably an early treatment of these higher risk populations.…”

“…Peripheral arterial disease (PAD) affects 15 to 40% of hemodialysis (HD) patients; despite diabetes is the main determinant of PAD, advanced renal failure represents an independent risk factor for foot ulcers. In the uremic milieu, PAD quickly shows an aggressive behavior, with high prevalence of ulceration and amputation; in addition renal subjects undergo fewer revascularization procedures, but experience increased perioperative complications and worse outcomes after interventions …”

Pre-operative ankle–brachial index for cardiovascular risk assessment in simultaneous pancreas–kidney transplant recipients: a simple and elegant strategy!

“…Previous studies have suggested higher rates of PAD among patients awaiting kidney transplantation and have shown a reduction in risk mortality after renal transplantation [2,25,26]. However, little is known about the prevalence of PAD as well as the feasibility and impact of preoperative ABI testing on long-term graft and patient outcomes in SPKT transplant recipients.…”