RATIONALE & OBJECTIVES Chronic kidney disease (CKD) is a potent risk factor for macrovascular disease and death. Peripheral artery disease (PAD) is more common in patients with CKD and is associated with lower-limb complications and mortality. We sought to compare the prevalence of PAD in and outside the setting of kidney disease and examine how PAD affects the risk for adverse health outcomes, specifically lower-limb complications, cardiovascular events, and survival. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 453,573 adult residents of Manitoba with at least 1 serum creatinine measurement between 2007 and 2014. EXPOSURE PAD defined by hospital discharge diagnosis codes and medical claims. OUTCOMES All-cause mortality, cardiovascular events, and lower-limb complications, including foot ulcers and nontraumatic amputations. ANALYTICAL APPROACH Survival analysis using Cox proportional hazards models. RESULTS The prevalence of PAD in our study population was 4.5%, and patients with PAD were older, were more likely to be male, and had a higher burden of comorbid conditions, including diabetes and CKD. PAD was associated with higher risks for all-cause mortality, cardiovascular events, and lower-limb complications in patients with estimated glomerular filtration rate (eGFR) ≥ 60mL/min/1.73m2, those with CKD GFR categories 3 to 5 (G3-G5), and those treated by dialysis (CKD G5D). Although HRs for PAD were lower in the CKD population, event rates were higher as compared with those with eGFR≥60mL/min/1.73m2. In particular, compared with patients with eGFR≥60mL/min/1.73m2 and without PAD, patients with CKD G5D had 10- and 12-fold higher risks for lower-limb complications, respectively (adjusted HRs of 10.36 [95% CI, 8.83-12.16] and 12.02 [95% CI, 9.58-15.08] for those without and with PAD, respectively), and an event rate of 75/1,000 patient-years. LIMITATIONS Potential undercounting of PAD and complications using administrative codes and the limited ability to examine quality-of-care indicators for PAD. CONCLUSIONS PAD is more common in patients with CKD G3-G5 and G5D compared with those with eGFR≥60mL/min/1.73m2 and frequently leads to lower-limb complications. Medical interventions and care pathways specifically designed to slow or prevent the development of lower-limb complications in this population are urgently needed.

中文翻译：

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周围动脉疾病：有或没有CKD的不良后果。

理由和目标慢性肾脏病（CKD）是大血管疾病和死亡的潜在危险因素。周围动脉疾病（PAD）在CKD患者中更为常见，并与下肢并发症和死亡率相关。我们试图比较PAD在肾脏疾病发生之内和之外的患病率，并研究PAD如何影响不良健康结果（特别是下肢并发症，心血管事件和生存）的风险。研究设计回顾性队列研究。地点和参与者马尼托巴省的453,573名成年居民在2007年至2014年期间至少进行了一次血清肌酐测量。结果全因死亡率，心血管事件和下肢并发症，包括足部溃疡和非创伤性截肢。分析方法使用Cox比例风险模型进行生存分析。结果本研究人群中PAD的患病率为4.5％，PAD患者年龄较大，男性较多，并且合并症（包括糖尿病和CKD）的负担更高。对于估计肾小球滤过率（eGFR）≥60mL / min / 1.73m2的患者，CKD GFR类别为3至5的患者，PAD与全因死亡率，心血管事件和下肢并发症的较高风险相关（G3-G5 ），以及那些通过透析治疗的患者（CKD G5D）。尽管CKD人群中PAD的HRs较低，但与eGFR≥60mL/ min / 1.73m2的人群相比，事件发生率更高。特别是，与eGFR≥60mL/ min / 1.73m2且无PAD的患者相比，患有CKD G5D的患者下肢并发症的风险分别高10倍和12倍（无和有HR的校正后HRs为10.36 [95％CI，8.83-12.16]和12.02 [95％CI，9.58-15.08] PAD），事件发生率为75 / 1,000患者-年。局限性使用行政法规对PAD的潜在低估和并发症，以及检查PAD的护理质量指标的能力有限。结论与eGFR≥60mL/ min / 1.73m2的患者相比，CKD G3-G5和G5D患者PAD更常见，并经常导致下肢并发症。迫切需要专门设计用于减缓或预防该人群下肢并发症发展的医疗干预措施。16]和12.02 [95％CI，9.58-15.08]分别针对不使用PAD和使用PAD的患者，事件发生率为75 / 1,000患者-年。局限性使用行政法规对PAD的潜在低估和并发症，以及检查PAD的护理质量指标的能力有限。结论与eGFR≥60mL/ min / 1.73m2的患者相比，CKD G3-G5和G5D患者PAD更常见，并经常导致下肢并发症。迫切需要专门设计用于减慢或预防该人群下肢并发症发展的医疗干预措施。16]和12.02 [95％CI，9.58-15.08]分别针对没有和有PAD的患者，事件发生率为75 / 1,000患者-年。局限性使用行政法规对PAD的潜在低估和并发症，以及检查PAD的护理质量指标的能力有限。结论与eGFR≥60mL/ min / 1.73m2的患者相比，CKD G3-G5和G5D患者PAD更常见，并经常导致下肢并发症。迫切需要专门设计用于减缓或预防该人群下肢并发症发展的医疗干预措施。局限性使用行政法规对PAD的潜在低估和并发症，以及检查PAD的护理质量指标的能力有限。结论与eGFR≥60mL/ min / 1.73m2的患者相比，CKD G3-G5和G5D患者PAD更常见，并经常导致下肢并发症。迫切需要专门设计用于减缓或预防该人群下肢并发症发展的医疗干预措施。局限性使用行政法规对PAD的潜在低估和并发症，以及检查PAD的护理质量指标的能力有限。结论与eGFR≥60mL/ min / 1.73m2的患者相比，CKD G3-G5和G5D患者PAD更常见，并经常导致下肢并发症。迫切需要专门设计用于减缓或预防该人群下肢并发症发展的医疗干预措施。