Published Online
on October 23, 2006

A more recent version of this article appeared on October 31, 2006

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Submitted on January 3, 2006
Revised on July 25, 2006
Accepted on August 18, 2006

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, and 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.).

^* To whom correspondence should be addressed. E-mail: Sanjay.Rajagopalan{at}osumc.edu.

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.

Key words: renal insufficiency, chronic • epidemiology • renal dialysis • morbidity • mortality • peripheral vascular disease

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