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(Circulation. 2006;114:1914-1922.)
© 2006 American Heart Association, Inc.

Epidemiology

Peripheral Arterial Disease in Patients With End-Stage Renal Disease

Observations From the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Sanjay Rajagopalan, MD^*; Santo Dellegrottaglie, MD^*; Anna L. Furniss, MS; Brenda W. Gillespie, PhD; Sudtida Satayathum, MS; Norbert Lameire, MD; Akira Saito, MD; Takashi Akiba, MD, PhD; Michel Jadoul, MD; Nancy Ginsberg, MS, RD; Marcia Keen, PhD; Friedrich K. Port, MD, MS; Debabrata Mukherjee, MD; Rajiv Saran, MD, MS, MRCP

From the Division of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus (S.R); Zena and M.A. Wiener Cardiovascular Institute and M.-J. and H.R. Kravis Center for Cardiovascular Health, Mount Sinai Medical Center, New York, NY (S.R., S.D.); University Renal Research and Education Association (A.L.F., S.S., F.K.P.), Kidney Epidemiology and Cost Center (B.W.G., R.S.), Department of Biostatistics (B.W.G.), and Division of Nephrology, School of Medicine (R.S.), University of Michigan, Ann Arbor; University Hospital Renal Division, Ghent, Belgium (N.L.); Institute of Medical Science, Tokai University, Kanagawa, Japan (A.S.); Blood Purification and Internal Medicine, Tokyo Women’s Medical University, Tokyo, Japan (T.A.); Nephrology Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Bruxelles, Belgium (M.J.); Department of Research, Renal Research Institute, New York, NY (N.G.); Department of Nephrology, Amgen, Inc, Thousand Oaks, Calif (M.K.); and Gill Heart Institute, Division of Cardiology, University of Kentucky, Lexington (D.M.).

Correspondence to Sanjay Rajagopalan, MD, Division of Cardiovascular Medicine, 473 W 12th Ave, Ohio State University, Columbus, OH 43202. E-mail Sanjay.Rajagopalan{at}osumc.edu

Received January 3, 2006; revision received July 25, 2006; accepted August 18, 2006.

Background— Patients with end-stage renal disease are at high risk for cardiovascular morbidity and mortality. The aims of the present study were to describe the prevalence of peripheral arterial disease (PAD) and its effects on prognosis and health-related quality of life (HRQOL) in an international cohort of patients on hemodialysis.

Methods and Results— Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective, international, observational study of hemodialysis patients (n=29 873), were analyzed. Associations between baseline clinical variables and PAD were evaluated by logistic regression analysis. Cox regression models were used to test the association between PAD and risk for all-cause mortality, cardiac mortality, and hospitalization. PAD was diagnosed in 7411 patients (25.3%) with significant geographic variation. Traditional cardiovascular risk factors including age, male sex, diabetes, hypertension, and smoking were identified, together with the duration of hemodialysis, as significant correlates of PAD. Diagnosis of PAD was associated with increased all-cause mortality (hazard ratio [HR]=1.36; P<0.0001), cardiac mortality (HR=1.43; P<0.0001), all-cause hospitalization (HR=1.19; P<0.0001), and hospitalization for a major adverse cardiovascular event (HR=2.05; P<0.0001). HRQOL questionnaires revealed physical health scores that were significantly lower in PAD compared with non-PAD patients (P<0.0001).

Conclusions— PAD is common in hemodialysis patients and is associated with increased risk of cardiovascular mortality, morbidity, and hospitalization and reduced HRQOL.

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