Circulation. 2004;109:320-323
Published online before print January 19, 2004, doi: 10.1161/01.CIR.0000114519.75433.DD
Published online before print January 19, 2004, doi: 10.1161/01.CIR.0000114519.75433.DD
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2004;109:320-323.)
© 2004 American Heart Association, Inc.
Brief Rapid Communications |
High Prevalence of Peripheral Arterial Disease in Persons With Renal Insufficiency
Results From the National Health and Nutrition Examination Survey 1999–2000
From the Division of Nephrology, VAMC San Francisco and University of California (A.M.O.), San Francisco, Calif; Department of Epidemiology and Biostatistics (D.V.G.), University of California, San Francisco, Calif; Framingham Heart Study (C.S.F.), National Heart, Lung, and Blood Institute, Framingham, Mass; and Division of Nephrology, University of California (C.H.), San Francisco, Calif.
Correspondence to Ann M. O’Hare, Staff Physician, VA Medical Center San Francisco, Box 111J Nephrology, 4150 Clement St, San Francisco, CA 94121. E-mail Ann.O'Hare{at}med.va.gov
Received November 3, 2003; revision received December 3, 2003; accepted December 4, 2003.
Background— Although renal insufficiency is a recognized risk factor for coronary artery disease, little is known about the epidemiology of lower-extremity peripheral arterial disease (PAD) in persons with renal insufficiency.
Methods and Results— We examined the cross-sectional association of PAD, defined as an ankle-brachial index (ABI) <0.9, and renal insufficiency, defined as an estimated creatinine clearance (CRCL) <60 mL · min-1 · 1.73 m-2, among 2229 eligible participants in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2000. An estimated 1.2±0.3 million persons 
40 years old with CRCL <60 mL · min-1 · 1.73 m-2 (24%) have PAD defined as an ABI <0.9 (versus 3.7% of persons with CRCL 60 mL · min-1 · 1.73 m-2). The association of ABI <0.9 with renal insufficiency was independent of potential confounders such as age, diabetes, hypertension, coronary artery disease, stroke history, and hypercholesterolemia (OR 2.5, 95% CI 1.2 to 5.1, P=0.011, referent category ABI 1.0 to 1.3).
Conclusions— Clinicians should be aware of the remarkably high prevalence of PAD among patients with renal insufficiency. In the clinical setting, accurate identification of patients with renal insufficiency combined with routine ABI measurement in this group would greatly enhance efforts to detect subclinical PAD.
Key Words: peripheral vascular disease • kidney • creatinine
This article has been cited by other articles:
 |
|
 |
|
  J. H. Ix, R. Katz, I. H. De Boer, B. R. Kestenbaum, M. A. Allison, D. S. Siscovick, A. B. Newman, M. J. Sarnak, M. G. Shlipak, and M. H. Criqui Association of chronic kidney disease with the spectrum of ankle brachial index the CHS (Cardiovascular Health Study). J. Am. Coll. Cardiol., September 22, 2009; 54(13): 1176 - 1184. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Balzer, S. van Hall, T. Rassaf, Y.-C. Boring, A. Franke, R. M. Lang, M. Kelm, and H. P. Kuhl Feasibility, safety, and efficacy of real-time three-dimensional transoesophageal echocardiography for guiding device closure of interatrial communications: initial clinical experience and impact on radiation exposure Eur J Echocardiogr, September 15, 2009; (2009) jep116v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Selvin, A. Kottgen, and J. Coresh Kidney function estimated from serum creatinine and cystatin C and peripheral arterial disease in NHANES 1999-2002 Eur. Heart J., August 1, 2009; 30(15): 1918 - 1925. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Wolf, N. Muller, M. Busch, G. Eidner, C. Kloos, W. Hunger-Battefeld, and U. A Muller Diabetic foot syndrome and renal function in type 1 and 2 diabetes mellitus show close association Nephrol. Dial. Transplant., June 1, 2009; 24(6): 1896 - 1901. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Balzer, M. Kelm, and H. P. Kuhl Real-time three-dimensional transoesophageal echocardiography for guidance of non-coronary interventions in the catheter laboratory Eur J Echocardiogr, May 1, 2009; 10(3): 341 - 349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Sanchez-Villanueva, A. Bajo, G. del Peso, M-J. Fernandez-Reyes, E. Gonzalez, S. Romero, P. Estrada, and R. Selgas Higher daily peritoneal protein clearance when initiating peritoneal dialysis is independently associated with peripheral arterial disease (PAD): A possible new marker of systemic endothelial dysfunction? Nephrol. Dial. Transplant., March 1, 2009; 24(3): 1009 - 1014. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 WRITING GROUP MEMBERS, D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, T. B. Ferguson, K. Flegal, E. Ford, K. Furie, A. Go, et al. Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 27, 2009; 119(3): e21 - e181. [Full Text] [PDF]
|
|
|
|
 |
|
 A. V. Kshirsagar, H. Bang, A. S. Bomback, S. Vupputuri, D. A. Shoham, L. M. Kern, P. J. Klemmer, M. Mazumdar, and P. A. August A Simple Algorithm to Predict Incident Kidney Disease Arch Intern Med, December 8, 2008; 168(22): 2466 - 2473. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Kumada, T. Aoyama, H. Ishii, M. Tanaka, Y. Kawamura, H. Takahashi, T. Toriyama, T. Aoyama, Y. Yuzawa, S. Maruyama, et al. Long-term outcome of percutaneous transluminal angioplasty in chronic haemodialysis patients with peripheral arterial disease Nephrol. Dial. Transplant., December 1, 2008; 23(12): 3996 - 4001. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. P. Liew, J. R. Bartholomew, S. Demirjian, J. Michaels, and M. J. Schreiber Jr. Combined Effect of Chronic Kidney Disease and Peripheral Arterial Disease on All-Cause Mortality in a High-Risk Population Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 1084 - 1089. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Margolis, O. Hofstad, and H. I. Feldman Association Between Renal Failure and Foot Ulcer or Lower-Extremity Amputation in Patients With Diabetes Diabetes Care, July 1, 2008; 31(7): 1331 - 1336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Writing Group Members, W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]
|
|
|
|
 |
|
 T. S. Perlstein, R. L. Pande, J. A. Beckman, and M. A. Creager Serum Total Bilirubin Level and Prevalent Lower-Extremity Peripheral Arterial Disease: National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 Arterioscler Thromb Vasc Biol, January 1, 2008; 28(1): 166 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. Chade, J. D. Krier, O. Galili, A. Lerman, and L. O. Lerman Role of Renal Cortical Neovascularization in Experimental Hypercholesterolemia Hypertension, October 1, 2007; 50(4): 729 - 736. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. DeLoach and E. R. Mohler III Peripheral Arterial Disease: A Guide for Nephrologists Clin. J. Am. Soc. Nephrol., July 1, 2007; 2(4): 839 - 846. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Ozsoy, W. A. van der Steeg, J. J. P. Kastelein, L. Arisz, and M. G. Koopman Dyslipidaemia as predictor of progressive renal failure and the impact of treatment with atorvastatin Nephrol. Dial. Transplant., June 1, 2007; 22(6): 1578 - 1586. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. H.H. Feringa, S. E. Karagiannis, M. Chonchol, R. Vidakovic, P. G. Noordzij, A. Elhendy, R. T. van Domburg, G. Welten, O. Schouten, J. J. Bax, et al. Lower Progression Rate of End-Stage Renal Disease in Patients with Peripheral Arterial Disease Using Statins or Angiotensin-Converting Enzyme Inhibitors J. Am. Soc. Nephrol., June 1, 2007; 18(6): 1872 - 1879. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Bang, S. Vupputuri, D. A. Shoham, P. J. Klemmer, R. J. Falk, M. Mazumdar, D. Gipson, R. E. Colindres, and A. V. Kshirsagar SCreening for Occult REnal Disease (SCORED): A Simple Prediction Model for Chronic Kidney Disease Arch Intern Med, February 26, 2007; 167(4): 374 - 381. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Rosamond, K. Flegal, G. Friday, K. Furie, A. Go, K. Greenlund, N. Haase, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 6, 2007; 115(5): e69 - e171. [Full Text] [PDF]
|
|
|
|
|
|
A. Guerrero, R. Montes, J. Munoz-Terol, A. Gil-Peralta, J. Toro, M. Naranjo, P. Gonzalez-Perez, C. Martin-Herrera, and A. Ruiz-Fernandez Peripheral arterial disease in patients with stages IV and V chronic renal failure Nephrol. Dial. Transplant., December 1, 2006; 21(12): 3525 - 3531. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.-W. Mui, M. Sleeswijk, H. van den Hout, J. van Baal, G. Navis, and A.-J. Woittiez Incidental Renal Artery Stenosis Is an Independent Predictor of Mortality in Patients with Peripheral Vascular Disease J. Am. Soc. Nephrol., July 1, 2006; 17(7): 2069 - 2074. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. de Silva, N. P. Nikitin, K. K.A. Witte, A. S. Rigby, K. Goode, S. Bhandari, A. L. Clark, and J. G.F. Cleland Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis Eur. Heart J., March 1, 2006; 27(5): 569 - 581. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. O'Hare, D. Bertenthal, A. N. Sidawy, M. G. Shlipak, S. Sen, and M.-M. Chren Renal Insufficiency and Use of Revascularization among a National Cohort of Men with Advanced Lower Extremity Peripheral Arterial Disease Clin. J. Am. Soc. Nephrol., March 1, 2006; 1(2): 297 - 304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Thom, N. Haase, W. Rosamond, V. J. Howard, J. Rumsfeld, T. Manolio, Z.-J. Zheng, K. Flegal, C. O'Donnell, S. Kittner, et al. Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 14, 2006; 113(6): e85 - e151. [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Hankey, P. E. Norman, and J. W. Eikelboom Medical Treatment of Peripheral Arterial Disease JAMA, February 1, 2006; 295(5): 547 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. O'Hare, A. B. Newman, R. Katz, L. F. Fried, C. O. Stehman-Breen, S. L. Seliger, D. S. Siscovick, and M. G. Shlipak Cystatin C and Incident Peripheral Arterial Disease Events in the Elderly: Results From the Cardiovascular Health Study Arch Intern Med, December 12, 2005; 165(22): 2666 - 2670. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. O'Hare, R. A. Rodriguez, and P. Bacchetti Low Ankle-Brachial Index Associated With Rise in Creatinine Level Over Time: Results From the Atherosclerosis Risk in Communities Study Arch Intern Med, July 11, 2005; 165(13): 1481 - 1485. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. R. Chade, A. Lerman, and L. O. Lerman Kidney in Early Atherosclerosis Hypertension, June 1, 2005; 45(6): 1042 - 1049. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. O'Hare, D. Bertenthal, M. G. Shlipak, S. Sen, and M.-M. Chren Impact of Renal Insufficiency on Mortality in Advanced Lower Extremity Peripheral Arterial Disease J. Am. Soc. Nephrol., February 1, 2005; 16(2): 514 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. A. Massy, O. Ivanovski, T. Nguyen-Khoa, J. Angulo, D. Szumilak, N. Mothu, O. Phan, M. Daudon, B. Lacour, T. B. Drueke, et al. Uremia Accelerates both Atherosclerosis and Arterial Calcification in Apolipoprotein E Knockout Mice J. Am. Soc. Nephrol., January 1, 2005; 16(1): 109 - 116. [Abstract] [Full Text] [PDF]
|
|