20
Diagnosis
Table 9. PAD-Related Risk Amplifiers
Risk Factor Epidemiology
Data Supporting Amplified Risk
(MACE, MALE, or Both)
CKD
• Estimated
glomerular
filtration rate
<60 mL/
min/1.73 m
2
.
Up to 25% of
patients with
CKD have PAD.
In a cohort study
of >40,000
patients with
PAD, 20.2% had
CKD stages 2
to 5.
CKD is associated with higher rates of the
composite cardiovascular death, MI, and
ischemic stroke (6.75 versus 3.72 events/100
patient-years; adjusted HR, 1.45 [95% CI,
1.30–1.63]).
e rates of all-cause death, cardiovascular
events, and lower-limb complications, including
amputation, are higher among patients with
CKD and PAD than those with only CKD.
Patients with CKD have a 1.8-fold higher risk of
CAD and a 2.5-fold increased risk of MI.
Despite a high risk of MACE, in the EUCLID
trial, the combination of PAD and CKD was
not associated with an increased risk of MALE,
hospitalization for ALI, or major amputation
(adjusted HR, 0.92 [95% CI, 0.66–1.28])
compared with PAD alone.
Revascularization for CLTI in patients with
CKD has a lower mortality rate (3.7% versus
5.3%; adjusted OR, 0.78 [95% CI, 0.72–0.84])
and major amputation rate (adjusted OR, 0.33
[95% CI, 0.32–0.35]; P<0.001) compared with
no revascularization.
Endovascular revascularization for CLTI with
CKD has a lower in-hospital mortality rate
compared with open surgical revascularization
(2.7% versus 4.7% [95% CI, 1.43–1.94]).
ESKD (ie, dialysis
dependence)
• Most advanced
stage of CKD
(stage 5)
Up to 45% of
patients on
dialysis have
PAD.
e 5-y survival rate among those with PAD
aer renal transplantation is 19% versus 48%
(P<0.001).
ESKD and PAD are associated with a higher
risk of lower extremity amputation and
readmission aer revascularization than in
patients with CKD and PAD.
Among patients with ESKD undergoing lower
extremity bypass, rates of limb salvage are lower
compared with kidney transplant recipients.
Microvascular
disease
• Abnormalities
of the
microvasculature,
often leading
to retinopathy,
neuropathy, and
nephropathy
Microvascular
disease increases
the risk of PAD
14-fold.
Among patients with PAD, concomitant
microvascular disease increased the risk
of amputation 12- to 22.7-fold during
longitudinal follow-up in 2 cohort studies
compared with those without microvascular
disease.
(cont'd)
