Risk Factors for Peripheral Arterial Disease Among Patients With Chronic Kidney Disease - 14/06/12
, Emile R. Mohler, MD b, †, Dawei Xie, PhD b, Michael G. Shlipak, MD c, Raymond R. Townsend, MD b, Lawrence J. Appel, MD d, Dominic S. Raj, MD e, Akinlolu O. Ojo, MD, PhD f, Martin J. Schreiber, MD g, Louise F. Strauss, MD h, Xiaoming Zhang, MS b, Xin Wang, MS b, Jiang He, MD, PhD a, i, L. Lee Hamm, MD aCRIC Investigators
Corresponding author: Tel: 504-988-5346; fax: 504-988-1909Résumé |
Patients with chronic kidney disease (CKD) have an increased risk for developing peripheral arterial disease (PAD). The aim of this study was to examine the cross-sectional association between novel risk factors and prevalent PAD in patients with CKD. A total of 3,758 patients with estimated glomerular filtration rates of 20 to 70 ml/min/1.73 m2 who participated in the Chronic Renal Insufficiency Cohort (CRIC) study were included in the present analysis. PAD was defined as an ankle-brachial index <0.9 or a history of arm or leg revascularization. After adjustment for age, gender, race, cigarette smoking, physical activity, history of hypertension and diabetes, pulse pressure, high-density lipoprotein cholesterol, estimated glomerular filtration rate, and CRIC clinical sites, several novel risk factors were significantly associated with PAD. For example, odds ratios for a 1-SD higher level of risk factors were 1.18 (95% confidence interval [CI] 1.08 to 1.29) for log-transformed high-sensitivity C-reactive protein, 1.18 (95% CI 1.08 to 1.29) for white blood cell count, 1.15 (95% CI 1.05 to 1.25) for fibrinogen, 1.13 (95% CI 1.03 to 1.24) for uric acid, 1.14 (95% CI 1.02 to 1.26) for glycosylated hemoglobin, 1.11 (95% CI 1.00 to 1.23) for log-transformed homeostasis model assessment of insulin resistance, and 1.35 (95% CI 1.18 to 1.55) for cystatin C. In conclusion, these data indicate that inflammation, prothrombotic state, oxidative stress, insulin resistance, and cystatin C were associated with an increased prevalence of PAD in patients with CKD. Further studies are warranted to examine the causal effect of these risk factors on PAD in patients with CKD.
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| The Chronic Renal Insufficiency Cohort (CRIC) study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, under a cooperative agreement (Grants 5U01DK060990, 5U01DK060984, 5U01DK06102, 5U01DK061021, 5U01DK061028, 5U01DK60980, 5U01DK060963, and 5U01DK060902). In addition, this work was supported in part by the following institutional Clinical Translational Science Awards and other National Institutes of Health, Bethesda, Maryland, grants: Johns Hopkins University UL1 RR-025005, University of Maryland GCRC M01 RR-16500, Case Western Reserve University Clinical and Translational Science Collaborative (University Hospitals of Cleveland, Cleveland Clinic Foundation, and MetroHealth) UL1 RR-024989, University of Michigan GCRC M01 RR-000042 and CTSA UL1 RR-024986, University of Illinois at Chicago Clinical Research Center, M01 RR-013987-06, Tulane/LSU/Charity Hospital General Clinical Research Center RR-05096, and NIH/NCRR UCSF-CTSI UL1 RR-024131 and 5K24DK002651. Additional support was provided by the National Center for Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland. |
Vol 110 - N° 1
P. 136-141 - juillet 2012 Retour au numéro
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