title: Subclinical peripheral artery disease in patients undergoing peritoneal dialysis: risk factors and outcome.
abstract: BACKGROUND
  Peripheral artery disease (PAD) is highly prevalent among patients in end-stage renal disease. The ankle-brachial index (ABI) is believed to be highly correlated with the subclinical PAD of lower extremities but little is known about the associated risk factors and outcome for PAD and ABI in patients on peritoneal dialysis (PD).
  
  
  METHODS
  We performed a cohort study of 153 patients from a single center receiving stable PD for more than 3 months. These patients were screened for subclinical PAD using the ABI measurement. The ABI was measured and a ratio of <0.9 was considered abnormal. Clinical outcomes included actuarial patient and technique survival in this study.
  
  
  RESULTS
  30 patients were classified into a subclinical PAD group. The prevalence of PAD (subclinical and overt) in our PD center was 19.61% (30/153). Advanced age, preexisting diabetes, preexisting cardiovascular and/or cerebrovascular disease (CVD), lower renal Kt/V urea, lower renal creatinine clearance (WCrCl), lower serum albumin level, and higher serum triglyceride level were risk factors for PAD in our PD center. Bivariate analysis showed that ABI was positively correlated with residual renal Kt/V urea and WCrCl, but was not correlated with peritoneal Kt/V urea and WCrCl. Patient and technique survival rates were significantly lower in the low ABI group than in the normal ABI group.
  
  
  CONCLUSIONS
  ABI is highly correlated with advanced age, preexisting diabetes, preexisting CVD, serum albumin, serum triglyceride, and residual renal clearance in PD patients. Also, lower ABI is independently associated with a high risk of patient mortality and PD technique failure.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Jiung-Hsiun
authors.initials: JH
authors.lastname: Liu
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Lin
authors.forename: Ya-Fei
authors.initials: YF
authors.lastname: Yang
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Liu
authors.forename: Huey-Liang
authors.initials: HL
authors.lastname: Kuo
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.forename: Che-Yi
authors.initials: CY
authors.lastname: Chou
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D001916:Brachial Artery / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D016909:Tibial Arteries / Q000503:physiopathology*