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Prevalence of intermittent claudication and risk factors for its development in patients on renal replacement therapy
A T Webb1, P J Franks, D A Reaveley
1Department of Medicine, Charing Cross Medical School, Charing Cross Hospital, London, U.K.
Insights
Symptomatic intermittent claudication (IC) affects 19% of patients undergoing renal replacement therapy (RRT). While smoking is common, hypertension and lipid issues may also contribute to IC in this population.
Area of Science:
- Nephrology
- Vascular Medicine
- Cardiovascular Epidemiology
Background:
- Intermittent claudication (IC) is a common manifestation of peripheral artery disease.
- Patients on renal replacement therapy (RRT) have a high burden of cardiovascular risk factors.
- The prevalence and specific risk factors for IC in RRT patients require further investigation.
Purpose of the Study:
- To determine the prevalence of symptomatic intermittent claudication (IC) in patients receiving renal replacement therapy (RRT).
- To identify clinical and demographic factors associated with IC in this patient cohort.
Main Methods:
- A cohort of 325 patients on RRT underwent assessment for symptomatic IC using a standard cardiovascular questionnaire.
- A case-control study was conducted, matching for age, sex, and treatment modality.
- Statistical analyses compared characteristics between patients with and without IC.
Main Results:
- Symptomatic IC was prevalent in 19% of RRT patients.
- IC was significantly associated with older age, male sex, smoking, higher systolic blood pressure, and dyslipidemia (elevated triglycerides, cholesterol, LDL cholesterol).
- While smoking was common (77%), its prevalence in RRT patients with IC was lower than typically observed in the general IC population.
Conclusions:
- Intermittent claudication is a common comorbidity in patients on renal replacement therapy.
- Factors beyond smoking, including hypertension, lipid abnormalities, and the uraemic state, likely contribute to IC development in RRT patients.
- Further research is warranted to elucidate the multifactorial etiology of IC in this vulnerable population.
Abstract:
The prevalence of symptomatic intermittent claudication (IC) was assessed using a standard cardiovascular questionnaire in a cohort of 325 patients on renal replacement therapy (RRT). IC was found in 19% of patients, 77% of whom were smokers and 22% diabetic. It was more common in men than women and in smokers than non-smokers (p < 0.001). Those with IC were significantly older (61 years vs. 50 years p < 0.001), smoked more (23 pack years vs. 12 pack years p = 0.002), had higher median systolic blood pressures (143 mmHg vs. 140 mmHg p = 0.041) and median triglyceride levels (2.07 mmol/l vs. 1.60 mmol/l p = 0.023) than those renal patients without IC. A case control study matching for age, sex and treatment revealed patients with IC to have higher median systolic blood pressure (147 mmHg vs. 140 mmHg p = 0.031), cholesterol (6.70 mmol/l vs. 5.90 mmol/l p = 0.029), LDL cholesterol (4.64 mmol/l vs. 3.86 mmol/l p = 0.011), and contained a greater proportion of smokers (78% vs. 50% p < 0.001). IC is common in patients on RRT. Whilst smoking was prevalent among those with IC it was much less frequent than in the general population with IC. Other factors such as hypertension, lipid abnormalities or the uraemic state itself may also be important in the development of IC in these patients.