Chronic kidney disease (CKD), defined by either microalbuminuria (MA) or a reduced
estimated glomerular filtration rate (eGFR), is associated with an increased risk
of peripheral arterial disease (PAD). The presence of both abnormalities might identify
a subgroup of adults at particularly high risk of PAD. Accordingly, we sought to evaluate
the combined effect of a reduced eGFR and MA on the prevalence of PAD among United
States adults. United States adults ≥40 years old (n = 6,951) participating in the
1999 to 2004 National Health and Nutrition Examination Survey were cross-classified
into 4 groups according to the presence or absence of MA (urinary albumin/creatinine
ratio ≥30 mg/g) and reduced eGFR (<60 mL/min/1.73 m2). PAD was defined as an ankle-brachial index of <0.9. The prevalence of PAD among
adults without MA or a reduced eGFR was 3.6% compared to 9.7%, 14.8%, and 25.4% among
adults with MA alone, reduced eGFR alone, and both reduced eGFR and MA, respectively.
After multivariate adjustment, the odds ratio for prevalent PAD associated with MA
alone, reduced eGFR alone, and both reduced eGFR and MA compared to those without
MA or reduced eGFR was 1.72 (95% confidence interval 1.16 to 2.55), 1.58 (95% confidence
interval 1.09 to 2.29), and 2.26 (95% confidence interval 1.30 to 3.94), respectively.
In conclusion, the coexistence of MA and reduced eGFR was associated with a high prevalence
of PAD and might be useful in identifying patients with vascular disease.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Subclinical peripheral arterial disease in patients with chronic kidney disease: prevalence and related risk factors.Kidney Int Suppl. 2005; (Jan): S44-S47
- Renal insufficiency and the risk of lower extremity peripheral arterial disease: results from the Heart and Estrogen/Progestin Replacement Study (HERS).J Am Soc Nephrol. 2004; 15: 1046-1051
- Prevalence of and risk factors for peripheral arterial disease in the United States: results from the national health and nutrition examination survey, 1999–2000.Circulation. 2004; 110: 738-743
- Kidney function and risk of peripheral arterial disease: results from the Atherosclerosis Risk in Communities (ARIC) study.J Am Soc Nephrol. 2007; 18: 629-636
Wattanakit K, Folsom AR, Criqui MH, Kramer HJ, Cushman M, Shea S, Hirsch AT. Albuminuria and peripheral arterial disease: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis Epub 2008 Feb 15.
- Human blood pressure determination by sphygmomanometry.Circulation. 1993; 88: 2460-2470
- Calibration of serum creatinine in the National Health and Nutrition Examination Surveys (NHANES) 1988–1994, 1999–2004.Am J Kidney Dis. 2007; 50: 918-926
- A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation.Ann Intern Med. 1999; 130: 461-470
- K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.Am J Kidney Dis. 2002; 39: S1-S266
- Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey.Am J Kidney Dis. 2003; 41: 1-12
- The association of microalbuminuria with clinical cardiovascular disease and subclinical atherosclerosis in the elderly: the Cardiovascular Health Study.Atherosclerosis. 2006; 187: 372-377
- Prevalence of peripheral arterial disease and associated risk factors in American Indians: the Strong Heart Study.Am J Epidemiol. 1999; 149: 330-338
- High prevalence of peripheral arterial disease in persons with renal insufficiency: results from the National Health and Nutrition Examination Survey 1999–2000.Circulation. 2004; 109: 320-323
- Relationship between ankle-brachial index and chronic kidney disease in hypertensive patients with no known cardiovascular disease.J Am Soc Nephrol. 2006; 17: S201-S205
- Albuminuria and renal insufficiency prevalence guides population screening: results from the NHANES III.Kidney Int. 2002; 61: 2165-2175
- Prevalence and risk factor analysis of microalbuminuria in Japanese general population: the Takahata study.Kidney Int. 2006; 70: 751-756
- Mortality over a period of 10 years in patients with peripheral arterial disease.N Engl J Med. 1992; 326: 381-386
- Ankle-arm index as a predictor of cardiovascular disease and mortality in the cardiovascular health study.Arterioscler Thromb Vasc Biol. 1999; 19: 538-545
- Coronary artery disease and peripheral vascular disease in chronic kidney disease: an epidemiological perspective.Cardiol Clin. 2005; 23: 285-298
- K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients.Am J Kidney Dis. 2005; 45: S1-S153
- ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation.Circulation. 2006; 113: e463-e654
- Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus.JAMA. 2003; 289: 3273-3277
- Microalbuminuria and carotid artery intima-media thickness in nondiabetic and NIDDM subjects: the Insulin Resistance Atherosclerosis Study (IRAS).Stroke. 1997; 28: 1710-1716
- Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin-dependent diabetes mellitus.Lancet. 1992; 340: 319-323
- Vascular calcification in long-term haemodialysis patients in a single unit: a retrospective analysis.Nephron. 1997; 77: 37-43
- Prospective study of hyperhomocysteinemia as an adverse cardiovascular risk factor in end-stage renal disease.Circulation. 1998; 97: 138-141
- Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the strong heart study.Circulation. 2004; 109: 733-739
Article Info
Publication History
Accepted:
June 28,
2009
Received in revised form:
June 28,
2009
Received:
May 3,
2009
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.