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Peripheral artery disease and risk of kidney outcomes: The Atherosclerosis Risk in Communities (ARIC) study.
- Source :
-
Atherosclerosis [Atherosclerosis] 2024 Oct; Vol. 397, pp. 118558. Date of Electronic Publication: 2024 Aug 08. - Publication Year :
- 2024
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Abstract
- Background and Aims: The potential impact of peripheral artery disease (PAD) on kidney outcomes is not well understood. The aim of this study was to explore the association between PAD and end-stage kidney disease (ESKD) and chronic kidney disease (CKD).<br />Methods: Among 14,051 participants (mean age 54 [SD 6 years]) from the Atherosclerosis Risk in Communities study, we categorized PAD status as symptomatic PAD (intermittent claudication or leg revascularization), asymptomatic PAD (ankle-brachial index [ABI] ≤0.90 without clinical history of symptoms), and ABI 0.91-1.00, 1.01-1.10, 1.11-1.20 (reference), 1.21-1.30, and >1.30. We evaluated their associations with two kidney outcomes: ESKD (the need of renal replacement therapy or death due to kidney disease) and CKD (ESKD cases or an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m <superscript>2</superscript> with a ≥25 % decline from the baseline) using multivariable Cox proportional hazards models.<br />Results: Over ∼30 years of follow-up, there were 598 cases of incident ESKD and 4686 cases of incident CKD. After adjusting for potential confounders, both symptomatic PAD and asymptomatic PAD conferred a significantly elevated risk of ESKD (hazard ratio 2.28 [95 % confidence interval 1.23-4.22] and 1.75 [1.19-2.57], respectively). Corresponding estimates for CKD were 1.54 (1.14-2.09) and 1.63 (1.38-1.93). Borderline low ABI 0.91-1.00 also showed elevated risk of adverse kidney outcomes after adjustment for demographic variables. Largely consistent results were observed across demographic and clinical subgroups.<br />Conclusions: Symptomatic PAD and asymptomatic PAD were independently associated with an elevated risk of ESKD and CKD. These results highlight the importance of monitoring kidney function in persons with PAD, even when symptoms are absent.<br />Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: K.M. reports personal fees from Fukuda Denshi and Kowa Company, Ltd. Outside of the submitted work. The other authors do not have relevant conflicts of interest.<br /> (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Subjects :
- Humans
Middle Aged
Male
Female
Risk Factors
United States epidemiology
Kidney physiopathology
Proportional Hazards Models
Incidence
Risk Assessment
Prospective Studies
Time Factors
Prognosis
Renal Replacement Therapy
Asymptomatic Diseases
Disease Progression
Peripheral Arterial Disease epidemiology
Peripheral Arterial Disease diagnosis
Peripheral Arterial Disease physiopathology
Kidney Failure, Chronic epidemiology
Kidney Failure, Chronic physiopathology
Kidney Failure, Chronic diagnosis
Glomerular Filtration Rate
Ankle Brachial Index
Renal Insufficiency, Chronic epidemiology
Renal Insufficiency, Chronic diagnosis
Renal Insufficiency, Chronic physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1484
- Volume :
- 397
- Database :
- MEDLINE
- Journal :
- Atherosclerosis
- Publication Type :
- Academic Journal
- Accession number :
- 39276420
- Full Text :
- https://doi.org/10.1016/j.atherosclerosis.2024.118558