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Combined Effect of Chronic Kidney Disease and Peripheral Arterial Disease on All-Cause Mortality in a High-Risk Population

Yin Ping Liew^*, John R. Bartholomew, Sevag Demirjian^*, Jeannie Michaels, and Martin J. Schreiber, Jr.^*

^* Department of Nephrology and Hypertension, Section of Vascular Medicine, Department of Cardiovascular Medicine, and Quality Management Department, Cleveland Clinic, Cleveland, Ohio

Correspondence: Dr. Martin J. Schreiber, Jr., Cleveland Clinic, Department of Nephrology & Hypertension, Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Desk A51, Cleveland, OH 44195. Phone: 216-444-6365; Fax: 216-444-9378; E-mail: schreim{at}ccf.org

Background and objectives: Chronic kidney disease (estimated glomerular filtration rate <60 ml/min per 1.73 m²) and peripheral arterial disease (ankle-brachial index <0.9) independently predict mortality. It was hypothesized that the risk for death is higher in patients with both chronic kidney disease and peripheral arterial disease compared with those with chronic kidney disease or peripheral arterial disease alone.

Design, setting, participants, & measurements: A total of 1079 patients who had an ankle-brachial index and serum creatinine recorded within 90 d of each other in 1999 were studied retrospectively. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation. Patients were categorized into four groups: Chronic kidney disease and peripheral arterial disease, chronic kidney disease alone, peripheral arterial disease alone, or no chronic kidney disease or peripheral arterial disease.

Results: The overall 6-yr mortality rate was 28% (n = 284). Patients with both chronic kidney disease and peripheral arterial disease had the highest mortality rate (45%) compared with patients with chronic kidney disease alone (28%), peripheral arterial disease alone (26%), and neither condition (18%). After adjustment for clinical and demographic variables, the chronic kidney disease and peripheral arterial disease group had an increased odds for death when compared with the no chronic kidney disease or peripheral arterial disease group or the single disease groups.

Conclusions: These findings indicate that patients with both chronic kidney disease and peripheral arterial disease have a significantly higher risk for death than patients with either disease alone.

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