Cardiovascular disease is the most common cause of death in patients with end-stage renal disease (ESRD) [1
]. Peripheral artery disease (PAD) is an important marker of systemic atherosclerosis, and often leads to significant morbidity and mortality, particularly in patients with ESRD [2
]. The National Health and Nutrition Examination Survey (NHANES) of 1999–2000 reported that PAD affects approximately 5 million adults, including 12-20% of Americans aged 65
years and older [3
]. The prevalence of PAD increases dramatically with age, but the actual prevalence may be underestimated. Experts have estimated that PAD affects approximately 8 million people in the U.S. alone [4
]. In contrast, little is known about the prevalence of PAD in Asian ESRD patients.
Despite the high prevalence of PAD and its association with increased cardiovascular disease, few PAD patients are given treatment for this condition, because most are asymptomatic [5
]. PAD often progresses silently until the onset of the most common symptom, intermittent claudication [2
]. However, in the general population, only about 10% of patients with PAD develop this classic symptom, about 40% have no complaint of leg pain, and about 50% have diverse leg symptoms that are not typical of classic claudication [4
PAD is considered a marker for systemic atherosclerotic disease. Patients with PAD have a four-to-five fold greater risk of dying from a cardiovascular event and a two-to-three fold higher overall mortality rate relative to patients without PAD [6
]. The irreversible and reversible risk factors associated with PAD are similar to those for ischemic heart disease [7
]. Although younger patients represent a small percentage of PAD cases, they have poorer long-term outcome and experience more complications associated with bypass revascularization surgery [6
]. There is a remarkably high prevalence of PAD in patients with renal insufficiency [8
]. In particular, 24% of the NHANES population older than 40
years with renal insufficiency had PAD, but only 3.7% with normal renal function had PAD, and this association was independent of diabetes, hypertension, and age [8
Increased duration of dialysis and conventional cardiovascular disease risk factors (other than hypertension and hyperlipidemia) are known risk factors for PAD [8
]. PAD has been diagnosed in 25.3% of ESRD patients, and the prevalence varied widely among different populations [5
]. A recent study of patients on maintenance ambulatory peritoneal dialysis (PD) indicated the prevalence of PAD was 27.4% of all patients, and was 45% in patients older than 70
The ankle-brachial pressure index (ABI) is the simplest, least expensive, and most reliable method of detecting atherosclerosis in asymptomatic individuals with suspected PAD [10
]. Numerous clinical and epidemiological studies have used the ABI to screen for PAD because PAD of the lower extremities is associated with poor overall prognosis [11
]. In the U.S., the prevalence of PAD is much higher in patients on hemodialysis (HD) than in age- and sex-matched healthy subjects [11
]. A Finnish study indicated the prevalence of an elevated ABI was 8.4% among patients referred for vascular consultation and that PAD was much more common in patients with renal failure [13
]. However, there is little available data on relationship of PAD and renal failure in Asian populations, and fewer data in PD patients.
In the present study, we compared HD and PD patients who were receiving maintenance dialysis in the Mackay Memorial Hospital (Taipei, Taiwan) to identify the prevalence and risk factors associated with PAD in ESRD patients and to compare prevalence and risk of PAD in HD and PD patients.