2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by O’Hare, A. M. Articles by Shlipak, M. G. Search for Related Content PubMed PubMed Citation Articles by O’Hare, A. M. Articles by Shlipak, M. G.

Renal Insufficiency and the Risk of Lower Extremity Peripheral Arterial Disease: Results from the Heart and Estrogen/Progestin Replacement Study (HERS)

Ann M. O’Hare^*, Eric Vittinghoff, Judith Hsia and Michael G. Shlipak^*,

*Departments of Medicine, VA Medical Center San Francisco and University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; and Department of Medicine, George Washington University, Washington, DC.

Correspondence to Dr. Ann M. O’Hare, Nephrology Division, Box 111J VA Medical Center San Francisco, 4150 Clement Street, San Francisco, CA 94121. Phone: 415-221-4810 ext. 4953; Fax: 415-750-6949; E-mail: Ann.O'Hare{at}med.va.gov

ABSTRACT. Renal insufficiency is a risk factor for coronary heart disease and stroke, but whether it predicts lower extremity peripheral arterial disease (PAD) is unknown. The authors evaluated was the association of baseline renal insufficiency with future PAD events in the Heart and Estrogen/Progestin Replacement Study (HERS) and follow-up study (HERS II). A total of 2763 postmenopausal women with known coronary heart disease were enrolled in HERS and randomly assigned to receive hormone therapy with conjugated estrogens and medroxyprogesterone acetate or placebo and followed for up to 8 yr for clinical end points. The outcome was time from randomization to first occurrence of either a lower extremity amputation, revascularization (surgical or percutaneous), or lumbar sympathectomy during follow-up. Incident lower extremity PAD event rates among women with creatinine clearances 60, 30 to 59, and <30 ml/min/1.73 m² were, respectively, 0.55%, 0.92%, and 2.73% per year. After multivariable proportional-hazard adjustment for potential confounders and other known risk factors for PAD, women with a creatinine clearance 30 to 59 ml/min/1.73 m² (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.04 to 2.54, P = 0.032) and <30 ml/min/1.73 m² (HR, 3.24; 95% CI, 1.20 to 8.78, P = 0.021) had a significantly increased risk of PAD compared with participants with a creatinine clearance 60 ml/min/1.73 m². Renal insufficiency was independently associated with future PAD events among postmenopausal women with coronary heart disease. Future studies should determine whether this association is present in other populations and investigate its potential mechanisms.

This article has been cited by other articles:

				D. J. Margolis, O. Hofstad, and H. I. Feldman Association Between Renal Failure and Foot Ulcer or Lower-Extremity Amputation in Patients With Diabetes Diabetes Care, July 1, 2008; 31(7): 1331 - 1336. [Abstract] [Full Text] [PDF]

				A. D. Pradhan, S. Shrivastava, N. R. Cook, N. Rifai, M. A. Creager, and P. M Ridker Symptomatic Peripheral Arterial Disease in Women: Nontraditional Biomarkers of Elevated Risk Circulation, February 12, 2008; 117(6): 823 - 831. [Abstract] [Full Text] [PDF]

				S. S. DeLoach and E. R. Mohler III Peripheral Arterial Disease: A Guide for Nephrologists Clin. J. Am. Soc. Nephrol., July 1, 2007; 2(4): 839 - 846. [Abstract] [Full Text] [PDF]

				H. H.H. Feringa, S. E. Karagiannis, M. Chonchol, R. Vidakovic, P. G. Noordzij, A. Elhendy, R. T. van Domburg, G. Welten, O. Schouten, J. J. Bax, et al. Lower Progression Rate of End-Stage Renal Disease in Patients with Peripheral Arterial Disease Using Statins or Angiotensin-Converting Enzyme Inhibitors J. Am. Soc. Nephrol., June 1, 2007; 18(6): 1872 - 1879. [Abstract] [Full Text] [PDF]

				K. Wattanakit, A. R. Folsom, E. Selvin, J. Coresh, A. T. Hirsch, and B. D. Weatherley Kidney Function and Risk of Peripheral Arterial Disease: Results from the Atherosclerosis Risk in Communities (ARIC) Study J. Am. Soc. Nephrol., February 1, 2007; 18(2): 629 - 636. [Abstract] [Full Text] [PDF]

				J. M. Mostaza, C. Suarez, L. Manzano, M. Cairols, F. Garcia-Iglesias, J. Sanchez-Alvarez, J. Ampuero, D. Godoy, A. Rodriguez-Samaniego, M. A. Sanchez-Zamorano, et al. Relationship between Ankle-Brachial Index and Chronic Kidney Disease in Hypertensive Patients with No Known Cardiovascular Disease J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S201 - S205. [Abstract] [Full Text] [PDF]

				A. Silvestro, N. Diehm, H. Savolainen, D.-D. Do, J. Vogele, F. Mahler, S. Zwicky, and I. Baumgartner Falsely high ankle-brachial index predicts major amputation in critical limb ischemia Vascular Medicine, May 1, 2006; 11(2): 69 - 74. [Abstract] [PDF]

				A. M. O'Hare, A. B. Newman, R. Katz, L. F. Fried, C. O. Stehman-Breen, S. L. Seliger, D. S. Siscovick, and M. G. Shlipak Cystatin C and Incident Peripheral Arterial Disease Events in the Elderly: Results From the Cardiovascular Health Study Arch Intern Med, December 12, 2005; 165(22): 2666 - 2670. [Abstract] [Full Text] [PDF]

				A. M. O'Hare, R. A. Rodriguez, and P. Bacchetti Low Ankle-Brachial Index Associated With Rise in Creatinine Level Over Time: Results From the Atherosclerosis Risk in Communities Study Arch Intern Med, July 11, 2005; 165(13): 1481 - 1485. [Abstract] [Full Text] [PDF]

				A. M. O'Hare, D. Bertenthal, M. G. Shlipak, S. Sen, and M.-M. Chren Impact of Renal Insufficiency on Mortality in Advanced Lower Extremity Peripheral Arterial Disease J. Am. Soc. Nephrol., February 1, 2005; 16(2): 514 - 519. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673