Peripheral artery disease and CKD: a focus on peripheral artery disease as a critical component of CKD care

Am J Kidney Dis. 2012 Oct;60(4):641-54. doi: 10.1053/j.ajkd.2012.02.340. Epub 2012 May 5.

Abstract

The incidence of peripheral artery disease (PAD) is higher in patients with chronic kidney disease (CKD) than in the general population. PAD is a strong independent risk factor for increased cardiovascular disease mortality and morbidity, including limb amputation, in persons with CKD. Diagnosis of PAD in patients with CKD may be challenging in the absence of classic intermittent claudication or the presence of atypical leg symptoms. In addition, pedal artery incompressibility may decrease the accuracy of ankle-brachial index measurement, the most common PAD diagnostic tool. Alternative methods such as toe-brachial index should be used if clinical suspicion persists despite a normal ankle-brachial index value. Aggressive risk-factor modification, including treatment of diabetes, hyperlipidemia, and hypertension and smoking cessation, should be mandatory in all patients. Treatment of all individuals with PAD should include antiplatelet medications and prescribed supervised exercise programs and/or cilostazol for individuals with claudication symptoms. Preventive foot care measures and a multidisciplinary approach involving podiatrists and vascular and wound care specialists should be used to reduce amputations. Revascularization for critical limb ischemia is associated with poor outcomes in patients with CKD with PAD. Future investigation is recommended to evaluate the benefit of earlier treatment strategies in this high cardiovascular disease risk population with CKD.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Amputation
  • Ankle Brachial Index
  • Atherosclerosis / epidemiology
  • Cilostazol
  • Diabetic Foot / therapy
  • Exercise Therapy
  • Humans
  • Incidence
  • Ischemia / epidemiology
  • Ischemia / therapy
  • Leg / blood supply
  • Leg / surgery
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / epidemiology*
  • Peripheral Arterial Disease / rehabilitation
  • Peripheral Arterial Disease / surgery
  • Phosphodiesterase 3 Inhibitors / therapeutic use
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prevalence
  • Renal Insufficiency, Chronic / epidemiology*
  • Renal Insufficiency, Chronic / therapy*
  • Risk Factors
  • Smoking Cessation
  • Tetrazoles / therapeutic use
  • Vascular Stiffness

Substances

  • Phosphodiesterase 3 Inhibitors
  • Platelet Aggregation Inhibitors
  • Tetrazoles
  • Cilostazol