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Peripheral arterial disease predicts overall and cardiovascular mortality in peritoneal dialysis patients
Shun-Li Tian1, Xin-Kui Tian, Qing-Feng Han
1Division of Nephrology, Peking University Third Hospital, Beijing, China.
Insights
Peripheral arterial disease (PAD) is common in elderly peritoneal dialysis patients and predicts higher risks of cardiovascular and overall mortality. Early identification and management of PAD are crucial for improving outcomes in this vulnerable population.
Area of Science:
- Nephrology
- Cardiology
- Geriatrics
Background:
- Peripheral arterial disease (PAD) is a manifestation of atherosclerosis, prevalent in dialysis patients.
- Cardiovascular disease (CVD) is the leading cause of death in dialysis patients.
- PAD predicts mortality in the general population, but its role in peritoneal dialysis (PD) patients is understudied.
Purpose of the Study:
- To investigate the association between PAD and mortality in elderly peritoneal dialysis patients.
- To identify PAD as a prognostic factor for cardiovascular and overall mortality in this cohort.
Main Methods:
- Prospective study of prevalent PD patients over 60 years old.
- PAD diagnosis via ankle-brachial index < 0.9 or intermittent claudication.
- Cox proportional hazard models and Kaplan-Meier survival analysis were used.
Main Results:
- 62% of 171 patients had PAD.
- PAD was independently associated with increased cardiovascular and overall mortality.
- Lower serum albumin also correlated with higher mortality.
Conclusions:
- PAD is highly prevalent in elderly PD patients.
- PAD is an independent predictor of both cardiovascular and overall mortality in this population.
- These findings highlight the importance of assessing PAD in PD patients.
Background:
Peripheral arterial disease (PAD) is an important manifestation of systemic atherosclerosis and is common among dialysis patients. Cardiovascular disease (CVD) accounts for the leading cause of mortality in dialysis patients, and PAD has been found as a predictor for cardiovascular as well as overall mortality in general population. However, the study on the role of PAD in the prognosis of peritoneal dialysis patients is rather limited.
Methods:
Prevalent continuous ambulatory peritoneal dialysis patients over 60 years old were recruited in this study and were followed-up regularly to death or the end of the study. The diagnosis of PAD was based on ankle-brachial pressure index (ABI) < 0.9 or intermittent claudication. Univariate and multivariate Cox proportional hazard models were used to identify the risk factors for cardiovascular and overall mortality. Survival curves were estimated by the Kaplan-Meier method followed by log-rank test to compare the mortality rate between PAD and non-PAD patients.
Results:
One hundred and seventy-one patients were included and 62 (36%) had PAD complication. In the follow-up of 24.4 (median 34.6) months, 36 deaths were recorded: 19 from PAD group and 17 from non-PAD group. Twenty-one patients died due to CVD: 13 from PAD group and 8 from non-PAD group. The presence of PAD and serum albumin was found independently associated with cardiovascular and overall mortality using Cox proportional hazards model.
Conclusion:
PAD is very common in aged peritoneal dialysis patients and independently associated with both cardiovascular and overall mortality.
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