Abstract: TH-PO700
Natural History of Peripheral Artery Disease in Patients with CKD
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention
Authors
- Chen, Jing, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
- Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Dorans, Kirsten S., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
- Cornell, Jerry, Tulane University, Harvey, Louisiana, United States
- Mahone, Erin, Tulane University, Harvey, Louisiana, United States
- Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States
- Chen, Teresa K., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Srivastava, Anand, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Toth-Manikowski, Stephanie M., University of Illinois Medical Center, Chicago, Illinois, United States
- Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- He, Hua, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
- He, Jiang, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
Background
The prevalence and risk of peripheral artery disease (PAD) are higher in patients with chronic kidney disease (CKD) compared to those without. The natural history of PAD in CKD has not been well studied.
Methods
We studied the natural history of PAD among 4571 participants without PAD procedures at baseline in the Chronic Renal Insufficiency Cohort (CRIC) Study. The mean follow-up duration is 7.6 years. Mixed effects models were used to assess the slope of change in ankle-brachial index (ABI). Cox proportional hazards models were used to examine the multivariable association of ABI slopes with PAD events, adjusting for time-updated confounding factors.
Results
The slopes of average annual ABI changes were characterized as rapidly (ABI change < - 0.03) or slowly (-0.3 to -0.001) decreasing, stable (<-0.001 to <0.001), rapidly (>0.05) or slowly (0.001 to 0.05) increasing. Compared to those with stable slope, multivariable-adjusted hazard ratios (95% CI) for incident PAD events were 2.80 (2.49, 3.17), 1.67 (1.55, 1.81), 1.42 (1.32, 1.54), and 1.92 (1.65, 2.23) for those with rapidly decreasing, slowing decreasing, slowly increasing, and rapidly increasing, respectively. The average time to develop the first PAD event was 7.38, 8.48, 8.46, 7.73, 7.50, or 6.59 years for those with baseline ABI of ≤0.9, >0.9-1.0, >1.0-1.2, >1.2-1.3, >1.3-1.4, or >1.4, respectively. Annual event rates per person year were 2.95%, 1.58%, 1.58%, 1.77%, 1.64%, or 2.64 % for CVD and 3.57%, 2.17%, 1.61%, 1.80%, 1.96%, or 2.03% for mortality by baseline ABI categories. Amputation and mortality rates were 17.86% and 8.74%, respectively, in year 1 and 22.02% and 13.69%, respectively, in year 5 after PAD-related revascularization.
Conclusion
This study indicates that either increase or decrease in ABI with time is associated with increased incident PAD events. Latent time of PAD is short for those with normal ABI. Complication rates are high among those with subclinical PAD. Prognosis is poor after revascularization. Our study suggests screening for PAD using ABI along with monitoring ABI changes may facilitate early detection of PAD progression and prevention. Further study is warranted to investigate the effect of intervention for significant change of ABI on improving clinical outcomes.
Funding
- NIDDK Support