Original Investigations: Pathogenesis and Treatment of Kidney Disease and Hypertension
The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: Requirements for diagnostics*,**,

Work performed in the Department of Internal Medicine, Tampere University Hospital, Finland.
https://doi.org/10.1053/ajkd.2002.34885Get rights and content

Abstract

Background: Knowledge of the prevalence of peripheral arterial disease (PAD) in patients with chronic renal failure (CRF) is limited because of a lack of uniformity in disease definition and recognition. Furthermore, little is known of the prevalence of medial arterial calcification (MAC) in patients with CRF. Our goal is to study the prevalence of PAD and MAC defined by ankle brachial index (ABI) or toe brachial index (TBI) measurements in a Finnish population of patients with CRF consisting of predialysis and dialysis patients, as well as renal transplant recipients. Methods: We examined 136 patients with CRF and 59 control subjects. Fifty-nine of the patients with CRF had moderate to severe predialysis CRF, 36 patients were on dialysis treatment, and 41 were renal transplant recipients. Mean age of patients was 51.9 ± 11.5 years, and 39 patients (29%) had diabetes. ABI and TBI were measured by means of photoplethysmography. The definition of PAD required an ABI value of 0.90 or less, a TBI value of 0.60 or less, or a previous positive lower-extremity angiogram result. ABI values of 1.3 or greater or incompressible arteries at ankle level indicated MAC. The presence of claudication was determined by an interview. Results: Prevalences of PAD on this study were 22.0% in patients with predialysis CRF, 30.6% in patients on dialysis treatment, 14.6% in renal transplant recipients, and 1.7% in the control group (P = 0.001). Prevalences of MAC were 23.7%, 41.7%, 23.1%, and 3.4% (P < 0.001), respectively. Only 9 patients had claudication, and 6 of those patients had PAD. Conclusion: Both asymptomatic PAD and MAC are common in patients with CRF. Therefore, we recommend the use of both ABI and TBI measurements in the evaluation of PAD in patients with CRF. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Patients

Study subjects included 136 patients with CRF and 59 control subjects. The patient group was composed of three subgroups: 59 predialysis patients with moderate to severe CRF (plasma creatinine ≥ 2.3 mg/dL [200 μmol/L]), 36 patients on maintenance dialysis treatment (22 patients, hemodialysis; 14 patients, peritoneal dialysis), and 41 renal transplant recipients.

The study population was selected from among patients living in Tampere, Finland, or neighboring municipalities, an area with a total

Methods

In this prospective cross-sectional study, all patients underwent a careful interview and clinical examination, with an evaluation of patient history based on hospital and outpatient records. Study subjects were examined during March 1998 and December 2000 by one examiner (Y.L.). Hypertension was diagnosed when a study subject had received medical treatment for hypertension or had a systolic blood pressure of 160 mm Hg or greater or diastolic blood pressure of 95 mm Hg or greater at the time of

Clinical characteristics of study groups

Age, sex, body mass index, serum creatinine level, and creatinine clearance, as well as the prevalence of hypertension and diabetes, are listed in Table 1.Dialysis patients and renal transplant recipients were younger than patients with predialysis CRF and a similar control group. There were more women (44%) among renal transplant recipients than the other groups; nevertheless, men were predominant in all groups. Nearly all patients had hypertension. Nine control subjects (15%) had blood

Discussion

Data from the Tampere District Kidney Register enabled us to reach not only renal transplant recipients, but also patients with moderate to severe predialysis CRF for this study. The age and sex distribution of study patients did not differ substantially from the parent population not included in these two subgroups. Therefore, we are able to generalize results of this study to apply to all patients with predialysis CRF and all renal transplant recipients in our area. The dialysis patients

Acknowledgements

The authors thank professor Amos Pasternack for support and guidance throughout the study.

References (33)

  • JA Dormandy et al.

    Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC)

    J Vasc Surg

    (2000)
  • TASC Working Group

    Management of peripheral arterial disease

    Eur J Vasc Endovasc Surg

    (2000)
  • FG Fowkes et al.

    Prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population

    Int J Epidemiol

    (1991)
  • AT Hirsch et al.

    Peripheral arterial disease detection, awareness, and treatment in primary care

    JAMA

    (2001)
  • SA Carter

    Role of pressure measurements, in Bernstein EF (ed): Vascular Diagnosis

  • RE Zierler et al.

    Physiologic assessment of peripheral arterial occlusive disease

  • Cited by (238)

    View all citing articles on Scopus
    *

    Supported in part by grants from the research fund of Tampere University Hospital; Maud Kuistila Memorial Foundation, Finland; University of Tampere Research Fund; Finnish Cultural Foundation; and the Kidney Foundation of Finland.

    **

    Address reprint requests to Yrjö Leskinen, MD, Department of Internal Medicine, Tampere University Hospital, PO Box 2000 FIN-33521 Tampere, Finland. E-mail: [email protected]

    0272-6386/02/4003-0005$35.00/0

    View full text