title: Peripheral vascular disease severity impacts health outcomes and health-related quality of life in maintenance hemodialysis patients in the HEMO Study.
abstract: BACKGROUND
  In patients with end-stage renal disease, peripheral vascular disease (PVD) is prevalent. We assessed the extent to which severity of PVD predicts mortality, hospitalizations and health-related quality of life (HRQOL) in hemodialysis (HD) patients enrolled in the Hemodialysis (HEMO) Study.
  
  
  METHODS
  We performed a subanalysis of the HEMO Study, a randomized controlled trial. Adjusted predictors of PVD were analyzed through a multivariable stepwise ordinal logistic model. Relationships between PVD severity and mortality and hospitalizations were determined with Cox proportional hazards models. Relationships between PVD severity and HRQOL were modeled via linear regression and generalized estimating equations.
  
  
  RESULTS
  Older age, diabetes, non-African-American race, ischemic heart disease, cerebrovascular disease and longer transplant wait time were associated with more severe PVD. Patients with severe PVD were more likely to suffer from all-cause mortality [hazard ratio (HR) 1.77, 95% confidence interval 1.30-2.40, P<0.001], cardiac death [HR 1.89 (95% confidence interval 1.15-3.11), P=0.001] and infectious death [HR 1.75 (95% confidence interval 1.30-2.34), P<0.001]. Increasing PVD severity was also associated with first cardiac hospitalization or all-cause mortality (P=0.05) and first cardiac hospitalization or cardiac death (P=0.03). HRQOL scores were lower for patients with increasingly severe PVD.
  
  
  CONCLUSIONS
  These findings underscore the burden of clinically symptomatic PVD in HD patients and its impact on morbidity and mortality. Whether early detection of PVD and prompt initiation of therapy to prevent its progression in the HD population would improve HRQOL and survival outcomes remain to be proven.
authors.affiliation: University of Pittsburgh School of Medicine, Department of Biostatistics, Pittsburgh, PA, USA.
authors.forename: Tao
authors.initials: T
authors.lastname: Liu
authors.forename: Kelly V
authors.initials: KV
authors.lastname: Liang
authors.forename: Alan
authors.initials: A
authors.lastname: Rosenbaum
authors.forename: Ryan
authors.initials: R
authors.lastname: Stephenson
authors.forename: Francis
authors.initials: F
authors.lastname: Pike
authors.forename: Lisa
authors.initials: L
authors.lastname: Weissfeld
authors.forename: Mark L
authors.initials: ML
authors.lastname: Unruh
mesh_terms: D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000209:etiology* / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate