Serum creatinine predicts mortality in patients with peripheral artery disease: influence of diabetes and hypertension.
BACKGROUND
Patients with renal insufficiency tend to suffer from advanced atherosclerosis and exhibit a reduced life expectancy. We investigated the association of renal impairment, traditional cardiovascular risk factors and all-cause mortality in patients with symptomatic peripheral artery disease (PAD).


METHODS
We studied 515 patients with advanced PAD (intermittent claudication, n = 410; critical ischemia, n = 105). Cardiovascular risk profile and calculated glomerular filtration rate (GFR) were obtained at baseline and patients were followed for median 21 months (interquartile range 12 to 25) for mortality.


RESULTS
Sixty-five patients (13%) died. Cumulative survival rates at 6, 12, and 24 months were 97%, 95%, and 89%, respectively. Adjusted hazard ratios for mortality according to decreasing quartiles of GFR were 1.2, 2.5, and 5.9 compared to the highest quartile (P < 0.001). The association between renal impairment and mortality was independent of diabetes and hypertension, suggesting that decreased GFR adds to the prognostic value of traditional cardiovascular risk factors.


CONCLUSIONS
Renal impairment is associated with an increased risk for mortality in patients with advanced peripheral artery disease, irrespective of the coincidence of arterial hypertension and diabetes mellitus. This suggests that impaired renal function exerts an unfavorable effect on patient's outcome, independently of these cardiovascular and renal risk factors.
Mlekusch
Wolfgang
W
Department of Angiology, Vienna General Hospital, Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Exner
Markus
M
Sabeti
Schila
S
Amighi
Jasmin
J
Schlager
Oliver
O
Wagner
Oswald
O
Minar
Erich
E
Schillinger
Martin
M
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
D001786:Blood Glucose; D003404:Creatinine