We evaluated the prevalence, predictors, and outcome of peripheral arterial disease (PAD) among hemodialysis (HD) patients (n = 252) in a prospective study (3-year follow-up) conducted in Qatar. Those with PAD (n = 97; 38.5%) were older and more likely to be males and to have diabetes mellitus, prior coronary artery disease (CAD), or cerebrovascular disease. Diabetic retinopathy was an independent predictor of PAD (adjusted odds ratio: 2.7; P = .004). Women had a higher mortality. Three-year all-cause mortality was high in the PAD group (adjusted hazard ratios [HRs] 2.92; 95% confidence interval [CI] 1.55-5.51). Other predictors of mortality were age (HR 1.06; 95% CI 1.04-1.10), number of vascular access (HR 2.3; 95% CI 1.04-5.01), and prior CAD (HR 1.8; 95% CI 1.05-3.49). Prevalence of PAD was high among HD patients. Early detection of PAD as well as diabetic retinopathy is of value in identifying an even higher risk population among HD patients.
Centers for Disease Control and Prevention (CDC): Lower extremity disease among persons aged >40 years with and without diabetes—United States, 1999-2002. MMWR Morb Mortal Wkly Rep. 2005;54(45):1158–1160.
2.
DeLoachSSMohlerER 3rd. Peripheral arterial disease: a guide for nephrologists. Clin J Am Soc Nephrol. 2007;2(4):839–846.
3.
LiewYPBartholomewJRDemirjianSMichaelsJSchreiberMJJr. Combined effect of chronic kidney disease and peripheral arterial disease on all-cause mortality in a high-risk population. Clin J Am Soc Nephrol. 2008;3(4):1084–1089.
4.
NorgrenLHiattWRDormandyJA. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(suppl 1): S1–S75.
5.
O’HareAMGliddenDVFoxCSHsuCY. High prevalence of peripheral arterial disease in persons with renal insufficiency: results from the national health and nutrition examination survey. Circulation. 2004;109(3):320–323.
6.
O’HareAJohansenK. Lower-extremity peripheral arterial disease among patients with end-stage renal disease. J Am Soc Nephrol. 2001;12(12):2838–2847.
7.
EggersPWGohdesDPughJ. Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population. Kidney Int. 1999;56(4):1524–1533.
8.
National Institute of Diabetes and Digestive and Kidney Diseases, Division of Kidney Urologic and Hematologic Diseases. Patients characteristics. In: United States Renal Data System, USRDS 2000 annual data report, Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Division of Kidney Urologic and Hematologic Diseases; 2000, 339–348.
9.
El-MenyarAZubaidMShehabA. Prevalence and impact of cardiovascular risk factors among patients presenting with acute coronary syndrome in the Middle East. Clin Cardiol. 2011;34(1):51–58.
10.
El-MenyarAZubaidMSulaimanK. In-hospital major clinical outcomes in patients with chronic renal insufficiency presenting with acute coronary syndrome: data from a Registry of 8176 patients. Mayo Clin Proc. 2010;85(4):332–340.
11.
El-MenyarAAAlbinaliHABenerAMohammedIAl SuwaidiJ. Prevalence and impact of diabetes mellitus in patients with acute myocardial infarction: a 10-year experience. Angiology. 2009Dec-2010;60(6):683–688.
12.
El-MenyarAAminHRashdanI. Ankle-brachial index and extent of atherosclerosis in patients from the Middle East (the AGATHA-ME study): a cross-sectional multicenter study. Angiology. 2009;60(3):329–334.
13.
ShigidiMMRamachandiranGRashedAHFituriOM. Demographic data and hemodialysis population dynamics in Qatar: A five year survey. Saudi J Kidney Dis Transpl. 2009;20(3):493–500.
14.
AbboudO. Incidence, prevalence, and treatment of end-stage renal disease in the Middle East. Ethn Dis. 2006;16(2 suppl 2): S2–2-4.
15.
RashedA, Aboud O. Renal transplantation: seventeen years of follow-up in Qatar.Transplant Proc. 2004;36(6):1835–1838.
16.
RajagopalanSDellegrottaglieSFurnissAL. Peripheral arterial disease in patients with end-stage renal disease: observations from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Circulation. 2006;114(18):1914–1922.
17.
OnoKTsuchidaAKawaiH. Ankle-brachial blood pressure index predicts all-cause and cardiovascular mortality in hemodialysis patients. J Am Soc Nephrol. 2003;14(6):1591–1598.
18.
ChenSCChangJMHwangSJ. Significant correlation between ankle-brachial index and vascular access failure in hemodialysis patients. Clin J Am Soc Nephrol. 2009;4(1):128–134.
19.
OgataHKumata-MaetaCShishidoK. Detection of peripheral artery disease by duplex ultrasonography among hemodialysis patients. Clin J Am Soc Nephrol. 2010;5(12):2199–2206.
20.
AdragaoTPiresABrancoP. Ankle--brachial index, vascular calcifications and mortality in dialysis patients. Nephrol Dial Transplant. 2012;27(1):318–325.
21.
KleinRMarinoEKKullerLH. The relation of atherosclerotic cardiovascular disease to retinopathy in people with diabetes in the cardiovascular health study. Br J Ophthalmol. 2002;86(1):84–90.
22.
van HeckeMVDekkerJMStehouwerCD. EURODIAB prospective complications study. Diabetic retinopathy is associated with mortality and cardiovascular disease incidence: the EURODIAB prospective complications study. Diabetes Care. 2005;28(6):1383–1389.
23.
KramerCKRodriguesTCCananiLHGrossJLAzevedoMJ. Diabetic retinopathy predicts all-cause mortality and cardiovascular events in both type 1 and 2 diabetes: meta-analysis of observational studies. Diabetes Care. 2011;34(5):1238–1244.
JuutilainenALehtoSRönnemaaTPyöräläKLaaksoM. Retinopathy predicts cardiovascular mortality in type 2 diabetic men and women. Diabetes Care. 2007;30(2):292–299.
26.
ResnickHELindsayRSMcDermottMMDevereuxRBJonesKLFabsitzRRHowardBV. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004;109(6):733–739.
27.
O'HareAMVittinghoffEHsiaJShlipakMG. Renal insufficiency and the risk of lower extremity peripheral arterial disease: results from the Heart and Estrogen/Progestin Replacement Study (HERS). J Am Soc Nephrol. 2004;15(4):1046–1051.
28.
AthyrosVGMitsiouEKTziomalosKKaragiannisAMikhailidisDP. Impact of managing atherogenic dyslipidemia on cardiovascular outcome across different stages of diabetic nephropathy. Expert Opin Pharmacother. 2010;11(5):723–730.
29.
ParaskevasKIKotsikorisIKoupidisSATzovarasAAMikhailidisDP. Cardiovascular events in chronic dialysis patients: emphasizing the importance of vascular disease prevention. Int Urol Nephrol. 2010;42(4):999–1006.
