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

Abstract

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 m 2 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 [

A Small Reduction in the Ankle-Brachial Index Is Associated with Increased Mortality in Patients on Chronic Hemodialysis

“…An increased ABI is also found in HD patients taking ACEIs or ARBs [28]. Long-term use of statins and ACEIs reduced the risk of all-cause mortality and cardiac events in a general PAD population not on dialysis [29]. In this study, we confirmed a significantly higher level of ABI in patients using ACEIs and/or ARBs than in those not on such treatment.…”

Low levels of high-density lipoproteins are associated with acute kidney injury following revascularization for chronic limb ischemia

“…17 In reality, patients with symptomatic PAD are at particularly high risk for having CKD. Feringa et al, 2 found that in patients with decreased (50.9) ankle-brachial index (ABI), 42% had mild, 22% had moderate and 3% had severe chronic kidney disease, amounting about two-thirds of patients with PAD, and statin use and ACEI has been reported to decrease or to slow the progression of CKD in these patients. 18 In addition to the presence of underlying renal disease, these patients carry a higher risk of CIN, with 1-2% reported incidence in patients with normal kidney function, increasing to 10% in patients with serum creatinine level of 1.3-1.9, and spiking up to 62% in patients with serum creatinine of !2.0.…”

“…[1][2][3] These patients often require interventions for their coronary artery disease (CAD), PAD or other vascular procedures, such as aneurysms, which may carry a significant risk of acute kidney injury (AKI), negatively impacting on the early and late outcomes following these interventions. The use of contrast agents has increased for invasive and noninvasive imaging as well as revascularization procedures, and the risk of contrast-induced nephropathy (CIN) has been reported to increase with worsening renal function, occurring in 1-2% in those with normal renal function, 10% in those with serum creatinine of 1.3-1.9, and 62% in those with 42.0.…”

Primary care-based disease management of chronic kidney disease (CKD), based on estimated glomerular filtration rate (eGFR) reporting, improves patient outcomes

“…The relationship between improved blood pressure control and reduction in the rate of progression is well documented [46]. There is also good evidence for the renoprotective effects of statins [45] and blockade of the rennin-angiotensin system [46,47]. Thus it is possible that the effects seen on the rate of progression of renal impairment are related to the reductions observed in blood pressure and cholesterol.…”