Peripheral Arterial Disease and Renal Transplantation

Abstract

It was hypothesized that peripheral arterial disease (PAD) is less frequent after kidney transplantation than among comparable patients who are on the deceased-donor waiting list. The cumulative incidences and risk factors for PAD were compared among 43,427 adult transplant recipients and 53,309 adults who were placed on the renal transplant waiting list between 1995 and 2003. All patients had Medicare primary insurance coverage, and Medicare claims were used to identify PAD. For patients with diabetes, the 3-yr cumulative incidence of de novo PAD was 24% on the waiting list versus 20% after transplantation. For patients without diabetes, the 3-yr cumulative incidence was 9% on the waiting list versus 5% after transplantation. The adjusted relative risk (RR) for PAD among patients without diabetes was 0.73 (95% confidence interval [CI] 0.66 to 0.80; P < 0.0001) in the transplant population versus the waiting list population, whereas among patients with diabetes, it was 0.88 (95% CI 0.82 to 0.96; P ‫؍‬ 0.0024). A diagnosis of PAD on the waiting list was associated with an almost three-fold increase in the RR for death for patients without diabetes (2.98; 95% CI 2.71 to 3.27; P < 0.0001) and with diabetes (2.92; 95% CI 2.71 to 3.15; P < 0.0001). After transplantation, de novo PAD increased the RR for death almost two-fold in patients without diabetes (1.92; 95% CI 1.63 to 2.26; P < 0.0001) and with diabetes (1.83; 95% CI 1.58 to 2.12; P < 0.0001). The incidence of PAD is higher on the waiting list than after transplantation and is associated with an increased risk for death among patients with and without diabetes.

Fasting Serum Long-Acting Natriuretic Peptide Correlates With the Ankle Brachial Index in Renal Transplant Recipients

“…15,16 The cumulative incidence of PAD has been found to be 20% and 5% in patients with and without diabetes at 3 years after transplant. 11 The prevalence of low ABI in this study was about 21.7%. Peripheral artery disease is highly prevalent among the elderly and subjects with atherosclerotic risk factors such as diabetes mellitus, hypertension, and hyperlipidemia.…”

“…5,6 Peripheral artery disease is associated with an increased risk of death among patients with and without diabetes after kidney transplant. 11 The incidence of PAD seems to vary and has been reported to range from 6.8% to 15% after a kidney transplant. 15,16 The cumulative incidence of PAD has been found to be 20% and 5% in patients with and without diabetes at 3 years after transplant.…”

“…9,10 Moreover, PAD is associated with an increased risk of death among patients with and without diabetes among kidney transplant patients. 11 Until now, no study has investigated serum LANP values in relation to ABI among renal transplant recipients. We sought to determine the relation between serum LANP concentrations and ABI among renal transplant recipients.…”

Medical Management of the Kidney Transplant Recipient

“…The prevalence of cerebrovascular events, though less than dialysis patients, is still high in patients who have undergone renal transplantation, and the risk of cerebral hemorrhage is higher than in the general population (24,25). Finally, incidence of peripheral arterial disease is lower in renal transplant recipients, though de novo peripheral arterial disease increases the relative risk for death by almost twofold (26).…”

Excess Risk of Death Increases with Time from First Dialysis for Patients on the Waiting List: Implications for Renal Allograft Allocation Policy

“…One explanation has been that the death rates of some wait-listed subgroups (e.g. patients with peripheral vascular disease or diabetes [13,14]) increase with time on dialysis, whereas transplantation would lengthen their survival [15]. Although some survival studies of wait-listed dialysis patients versus kidney transplant recipients have expressed their results in projected years of life gained [5] or long-term hazard ratios for death [5,6], assessment of current graft allocation policies requires a comparison of the death rates according to ESRD duration.…”