Unique aspects of peripheral artery disease in patients with chronic kidney disease

Area of Science:

• Nephrology
• Vascular Medicine
• Cardiovascular Research

Background:

• Peripheral artery disease (PAD) poses a significant healthcare challenge.
• Suboptimal long-term outcomes persist despite advancements in screening and interventions, particularly for patients with chronic kidney disease (CKD).
• CKD is increasingly recognized as an independent and potent risk factor for PAD, beyond shared predisposing factors.

Purpose of the Study:

• To review the unique clinical features of PAD in CKD patients.
• To highlight the mechanisms behind poor outcomes after PAD interventions in CKD.
• To emphasize the need for investigating CKD-specific pathogenic pathways in PAD.

Main Methods:

• Literature review focusing on the intersection of PAD and CKD.
• Analysis of clinical outcomes, risk factors, and intervention results in CKD patients with PAD.
• Discussion of emerging evidence on CKD-specific mediators and pathogenic pathways.

Main Results:

• PAD exhibits higher prevalence and worse outcomes in CKD patients, including after vascular interventions.
• Renal allograft transplantation influences PAD.
• Disparities in revascularization rates and increased peri-procedural mortality are noted in CKD patients with PAD.

Conclusions:

• CKD is a critical independent risk factor for PAD, necessitating a focus on CKD-specific pathogenic mechanisms.
• Further research into these pathways may reveal novel biomarkers and therapeutic targets for improved risk stratification and management of PAD in CKD patients.
• Addressing disparities in care and understanding peri-procedural risks are essential for optimizing outcomes.