Peripheral arterial disease, chronic kidney disease, and mortality: the Chinese Ankle Brachial Index Cohort Study

The purpose of this study was to investigate the association between chronic kidney disease (CKD) and peripheral arterial disease (PAD) and examine the combined effect of CKD and PAD on all-cause and cardiovascular disease (CVD) mortality. The Chinese Ankle Brachial Index Cohort consisted of 3732 adults aged 35 years or older enrolled in 2004 and followed-up in 2007. Complete baseline data were compiled on 3610 people which were examined in the final analysis. Mortality surveillance was completed from December 2007 to February 2008. Survival analysis was used to compare the survival rate in different CKD/PAD groups. The relative risks (RR) of death from all-cause and CVD were compared using a Cox regression model. It was found that the prevalence of PAD in patients with and without CKD was 41.9% and 22.3%, respectively (p < 0.001). The survival rate for the CKD and PAD group was significantly lower than that for any single disease, for both all-cause and CVD mortality (log-rank: p < 0.001). In conclusion, CKD is a risk factor for PAD. The combined CKD and PAD patients had the highest risk for all-cause and CVD mortality. Early recognition of risk can be made by taking an ankle-brachial index measurement of PAD; a corresponding laboratory assessment should be used as a measurement of renal function for PAD patients.