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Kidney Function and Risk of Peripheral Arterial Disease: Results from the Atherosclerosis Risk in Communities (ARIC) Study

Keattiyoat Wattanakit^*, Aaron R. Folsom^*, Elizabeth Selvin, Josef Coresh, Alan T. Hirsch^* and Beth D. Weatherley

^* Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Welch Center for Prevention, Epidemiology and Clinical Research and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina

Address correspondence to: Dr. Aaron R. Folsom, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 South Second Street, Minneapolis, MN 55454-1015. Phone: 612-626-8862; Fax: 612-624-0315; folsom{at}epi.umn.edu

Received for publication November 19, 2005. Accepted for publication December 4, 2006.

Chronic kidney disease (CKD) is associated with an increased risk for cardiovascular disease, but its association with peripheral arterial disease (PAD) is unclear. With the use of data from the Atherosclerosis Risk in Communities (ARIC) Study, 14,280 middle-aged adults were categorized on the basis of estimated GFR 90, 60 to 89, and 15 to 59 ml/min per 1.73 m² for normal kidney function, mildly decreased kidney function, and stages 3 to 4 CKD, respectively. Incident PAD was defined as a new onset of ankle-brachial index <0.9 assessed at regular examinations, new intermittent claudication assessed by annual surveillance, or PAD-related hospital discharges. Incidence rates and relative risks (RR) for PAD were compared across these categories. During a mean follow-up time of 13.1 yr (186,616 person-years), 1016 participants developed PAD. The incidence rates per 1000 person-years were 4.7, 4.9, and 8.6 for the normal kidney function, mildly decreased kidney function, and CKD groups, respectively. Compared with participants with normal kidney function, the age-, gender-, race-, and ARIC field center–adjusted RR for PAD was 1.04 (95% confidence interval [CI] 0.91 to 1.18) for those with mildly decreased kidney function and 1.82 (95% CI 1.34 to 2.47) for those with CKD. After additional adjustment for cardiovascular disease risk factors, an increase in risk for incident PAD still was observed in participants with CKD, with a multivariable adjusted RR of 1.56 (95% CI 1.13 to 2.14). Patients with CKD are at increased risk for incident PAD. Development of strategies for screening and prevention of PAD in this high-risk population seems warranted.

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