High prevalence of peripheral arterial disease in persons with renal insufficiency: results from the National Health and Nutrition Examination Survey 1999-2000.
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.


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.
O'Hare
Ann M
AM
Staff Physician, VA Medical Center San Francisco, Box 111J Nephrology, 4150 Clement St, San Francisco, CA 94121, USA. Ann.O'Hare@med.va.gov
Glidden
David V
DV
Fox
Caroline S
CS
Hsu
Chi-Yuan
CY
D000328:Adult; D000368:Aged; D000842:Ankle / Q000098:blood supply; D001158:Arteries; D001916:Brachial Artery / Q000503:physiopathology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D051437:Renal Insufficiency / Q000150:complications*; D012307:Risk Factors