The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics.
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.


CONCLUSIONS
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.
Department of Internal Medicine, the Division of Vascular Surgery, Centre for Laboratory Medicine, Tampere University Hospital, Tampere, Finland. yrjo.leskinen@uta.fi
Yrjö
Y
Leskinen
Juha P
JP
Salenius
Terho
T
Lehtimäki
Heini
H
Huhtala
Heikki
H
Saha
D001161:Arteriosclerosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005387:Finland; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D010530:Peritoneal Dialysis; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis; D017540:Tunica Media / Q000378:metabolism / Q000473:pathology