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Lower Progression Rate of End-Stage Renal Disease in Patients with Peripheral Arterial Disease Using Statins or Angiotensin-Converting Enzyme Inhibitors

Harm H.H. Feringa^*, Stefanos E. Karagiannis^*, Michel Chonchol, Radosav Vidakovic^*, Peter G. Noordzij, Abdou Elhendy, Ron T. van Domburg^*, Gijs Welten^||, Olaf Schouten^||, Jeroen J. Bax^¶, Tomas Berl and Don Poldermans

^* Departments of Cardiology, Anesthesiology, and ^|| Vascular Surgery, Erasmus Medical Center, Rotterdam, Netherlands; Division of Renal Diseases and Hypertension, University of Colorado Health Science Center, Denver, Colorado; Internal Medicine, Section of Cardiology, University of Nebraska, Omaha, Nebraska; and ^¶ Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands

Address correspondence to: Dr. Don Poldermans, Dr. Molewaterplein 40, Room H-921, 3015 GD Rotterdam, the Netherlands. Phone: +31-10-463-4613; Fax: +31-10-463-4957; E-mail: d.poldermans{at}erasmusmc.nl

Received for publication August 22, 2006. Accepted for publication March 20, 2007.

Patients with peripheral arterial disease (PAD) are at increased risk for ESRD and cardiovascular events. The primary objective was to assess the association between ankle-brachial index (ABI) values and renal outcome. The secondary objective was to evaluate whether statins and angiotensin-converting enzyme inhibitors (ACEI) are associated with improved renal and cardiovascular outcome in patients with PAD. In a prospective observational cohort study of 1940 consecutive patients with PAD, ABI was measured and chronic statin and ACEI therapy was noted at baseline. Serial creatinine concentrations were obtained at baseline, 6 mo, and every year after enrollment. End points were ESRD, all-cause mortality, and cardiac events during a median follow-up period of 8 yr. Baseline estimated GFR <60 ml/min per 1.73 m² was assessed in 27% of patients. ESRD, all-cause mortality, and cardiac events occurred in 10, 46, and 31% of patients, respectively. In multivariate analysis, a lower baseline ABI was significantly associated with a higher progression rate of ESRD (hazard ratio [HR] per 0.10 decrease 1.34; 95% confidence interval [CI] 1.21 to 1.49). Chronic use of statins and ACEI were significantly associated with lower ESRD (HR 0.41 [95% CI 0.28 to 0.63] and 0.74 [95% CI 0.54 to 0.98], respectively), mortality (HR 0.66; [95% CI 0.55 to 0.82] and 0.84 [95% CI 78 to 0.95], respectively), and cardiac events (HR 0.71 [95% CI 0.56 to 0.91] and 0.81 [95% CI 0.68 to 0.96], respectively). In patients with PAD, low ABI values independently predict the onset of ESRD. Less progression toward ESRD and improved cardiovascular outcome was observed among patients who were on long-term statins and ACEI.

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