Risk factors for peripheral arterial disease among patients with chronic kidney disease

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Internal Medicine

Background:

• Chronic kidney disease (CKD) significantly elevates the risk of developing peripheral arterial disease (PAD).
• Understanding novel risk factors associated with PAD in CKD patients is crucial for early detection and intervention.

Purpose of the Study:

• To investigate the cross-sectional association between various novel risk factors and the prevalence of PAD in a large cohort of CKD patients.
• To identify specific biomarkers and conditions contributing to PAD development in individuals with impaired kidney function.

Main Methods:

• Analysis of 3,758 patients from the Chronic Renal Insufficiency Cohort (CRIC) study with estimated glomerular filtration rates between 20-70 ml/min/1.73 m(2).
• Peripheral arterial disease (PAD) was defined by ankle-brachial index <0.9 or history of revascularization.
• Statistical models adjusted for traditional risk factors, including age, gender, race, smoking, hypertension, diabetes, and lipid profiles.

Main Results:

• Several novel risk factors demonstrated significant associations with prevalent PAD after multivariable adjustment.
• Elevated levels of high-sensitivity C-reactive protein, white blood cell count, fibrinogen, uric acid, glycosylated hemoglobin, insulin resistance (HOMA-IR), and cystatin C were independently linked to PAD.
• Odds ratios for a 1-SD increase in these factors ranged from 1.11 to 1.35, indicating increased PAD risk.

Conclusions:

• Inflammation, prothrombotic state, oxidative stress, insulin resistance, and elevated cystatin C are associated with a higher prevalence of PAD in CKD patients.
• These findings highlight potential targets for risk stratification and therapeutic strategies in managing PAD within the CKD population.
• Further research is needed to establish causality and explore interventions targeting these novel risk factors.