Outcomes of Peripheral Artery Disease and Polyvascular Disease in Patients with End Stage Kidney Disease.

BACKGROUND: Patients with peripheral artery disease (PAD) and end stage kidney disease (ESKD) are a high-risk population, and concomitant atherosclerosis in coronary arteries (CAD) or cerebral arteries (CVD) is common.

OBJECTIVES: The aim of the study was to assess long-term outcomes of PAD and the impact of coexistent CAD and CVD on outcomes.

METHODS: The United States Renal Data System was used to identify patients with PAD within 6 months of incident dialysis. Four groups were formed: PAD alone, PAD with CAD, PAD with CVD, and PAD with CAD and CVD. PAD-specific outcomes (chronic limb-threatening ischemia, major amputation, percutaneous/surgical revascularization, and their composite, defined as major adverse limb events (MALE)) as well as all-cause mortality, myocardial infarction, and stroke were studied.

RESULTS: The study included 106,567 patients (mean age 71.2 years, female 40.8%) with a median follow-up of 546 days (IQR, 214 - 1096). Most patients had PAD and CAD (49.8%), 25.8% had PAD alone, and 19.2% had all three territories involved. MALE rate in PAD patients was 22.3% and 35.0% at 1 and 3 years, respectively. In comparison to PAD alone, the coexistence of both CAD and CVD i.e., Polyvascular disease was associated with a higher adjusted rates of all-cause mortality (HR 1.28; 95%CI 1.24-1.31), myocardial infarction (HR 1.78; 95%CI 1.69-1.88), stroke (HR 1.66; 95%CI 1.52,1.80) and MALE (HR 1.07; 95%CI 1.04-1.11).

CONCLUSION: Patients with ESKD have a high burden of PAD with poor long-term outcomes, which worsen, in an incremental fashion, with the involvement of each additional diseased arterial bed.