title: Presence of peripheral arterial disease predicts loss of residual renal function in incident CAPD patients.
abstract: BACKGROUND
  Accelerated cardiovascular disease (CVD), including peripheral arterial disease (PAD), is very common in patients with end-stage renal disease. Residual renal function (RRF) is a strong predictor of patient survival that is suggested to be linked to the degree of CVD. However, the relationship between PAD and decline in RRF has not previously been measured.
  
  
  METHODS
  We studied incident continuous ambulatory peritoneal dialysis patients from Peking University Third Hospital. An ankle brachial index of less than 0.9 was used to diagnose PAD. Residual renal function (RRF) was determined as the mean of 24-hour urea and creatinine clearances (glomerular filtration rate). The Cox proportional hazards model was used to identify factors predicting loss of RRF.
  
  
  RESULTS
  The study included 86 patients (age: 61 ± 14 years; men: 51%), 23 of whom had PAD at baseline. Mean follow-up was 19 months (median: 18 months; range: 6 - 30 months). In univariate analysis, baseline PAD, peritonitis during follow-up, inflammation (C-reactive protein), serum uric acid, Ca×P, and serum phosphate were all significantly associated with a greater-than-50% decrease in RRF during follow-up. In multivariate analysis, only baseline PAD, Ca×P, and peritonitis were independently associated with a decline in RRF.
  
  
  CONCLUSIONS
  Our study suggests that PAD may be a clinically important marker of CVD predicting the loss of RRF. It remains to be determined whether interventions aimed at decreasing PAD may also improve renal vascular status and thus slow the rate of RRF decline.
authors.affiliation: Tianjin Geriatric Institute, Tianjin Medical University General Hospital, Tianjin, PR China.
authors.forename: Shun-li
authors.initials: SL
authors.lastname: Tian
authors.forename: Xin-kui
authors.initials: XK
authors.lastname: Tian
authors.forename: Qing-feng
authors.initials: QF
authors.lastname: Han
authors.forename: Jonas
authors.initials: J
authors.lastname: Axelsson
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000378:metabolism; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014508:Urea / Q000378:metabolism
chemical_list: D014508:Urea; D003404:Creatinine