Houssam K. Younes1, Mark G. Davies1, Javier Anaya-ayala1, Hosam F. El-Sayed2, Jean Bismuth1, Alan Lumsden1, Eric K. Peden2
1Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, TX; 2Dialysis Access Program, The Methodist Hospital, Houston, TX.
OBJECTIVES: The prevalence of peripheral arterial disease (PAD) and cardiovascular (CV) risk factors are more common in end-stage renal disease (ESRD) patients than the general population. The purpose of the study is to identify those patients that are most in need of PAD screening and examine those with impairments in quality of life that may be amenable to improvement.
METHODS: We conducted a cross-sectional pilot study by screening ESRD patients for PAD and its risk factors in different geographically representable locations of the metropolitan city of Houston. Data was obtained using medical record abstraction, patient interview, physical examination, non-invasive vascular screening imaging and patient-completed questionnaires. Multivariant regression models were used to test the association between PAD and risk for all-cause mortality. Average follow up was 18 months.
RESULTS: We screened 382 ESRD patients. Seventy-seven patients had known PAD. On exam, an additional 166 patients were newly diagnosed with PAD (43%). CV risk factors including age (51 years old), male sex (50%), diabetes (54%), hypertension (94%) and smoking (33%) were identified. On exam, 101 patient were found to have foot wounds, only 29% of which were followed by a specialist (11% vascular surgeons). Diagnosis of PAD was associated with increased all-cause mortality 20.2% vs. 10.8% (p=0.004), major adverse cardiovascular events (MACE) 20% vs. 10.1% (p=0.001) and amputations 14.4% vs. 0% (p<0.001) when compared to non-PAD patient. HRQOL questionnaires revealed physical health scores that were significantly lower in PAD compared with non-PAD patients.
CONCLUSIONS: PAD is under-recognized in ESRD patients and risk factors are not being treated. Screening and awareness of PAD in the ESRD/HD population should be enhanced. Further research is needed to evaluate whether early detection and treatment results in preventable, or at least mitigated, consequences of disease in ESRD patients
AUTHOR DISCLOSURES: J. Anaya-ayala: Nothing to disclose; J. Bismuth: Nothing to disclose; M. G. Davies: Nothing to disclose; H. F. El-Sayed: Nothing to disclose; A. Lumsden: Nothing to disclose; E. K. Peden: Nothing to disclose; H. K. Younes: Nothing to disclose.
Posted April 2013