The incidence of peripheral artery disease (PAD) is higher in patients with chronic kidney disease (CKD) than in the general population. PAD is a strong independent risk factor for increased cardiovascular disease mortality and morbidity, including limb amputation, in persons with CKD. Diagnosis of PAD in patients with CKD may be challenging in the absence of classic intermittent claudication or the presence of atypical leg symptoms. In addition, pedal artery incompressibility may decrease the accuracy of ankle-brachial index measurement, the most common PAD diagnostic tool. Alternative methods such as toe-brachial index should be used if clinical suspicion persists despite a normal ankle-brachial index value. Aggressive risk-factor modification, including treatment of diabetes, hyperlipidemia, and hypertension and smoking cessation, should be mandatory in all patients. Treatment of all individuals with PAD should include antiplatelet medications and prescribed supervised exercise programs and/or cilostazol for individuals with claudication symptoms. Preventive foot care measures and a multidisciplinary approach involving podiatrists and vascular and wound care specialists should be used to reduce amputations. Revascularization for critical limb ischemia is associated with poor outcomes in patients with CKD with PAD. Future investigation is recommended to evaluate the benefit of earlier treatment strategies in this high cardiovascular disease risk population with CKD.
Bibliographical noteFunding Information:
Financial Disclosure: Dr O'Hare has received royalties from UpToDate. Dr Herzog has consulted for Amgen; received research support from the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; received honoraria from UpToDate; served on the Medical Advisory Board for Fresenius; served on the Board of Trustees for the TruRoche Foundation for Anemia Research; has equity interest in Cambridge Heart, Merck, Boston Scientific, and Johnson & Johnson; has consulted for Merck, CorMedix, Abbott Labs, FibroGen, and Affymax; and has received research funding from Johnson & Johnson. Dr Hirsch has received research grants from Cytokinetics , Viromed , Sanofi Aventis , and Summit Doppler and has consulted for AstraZeneca, Merck, Novartis, and Pozen. The other authors declare that they have no relevant financial interests.
- Peripheral artery disease
- ankle-brachial index
- chronic kidney disease