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The Relationship Between Kidney Disease & Peripheral Arterial Disease

May 06, 2020
Dr. Beheshtian Dr. Beheshtian
Kidney disease and PAD

Across countless studies globally, it has been found that individuals with chronic kidney disease are more likely to develop or show signs of peripheral arterial disease than individuals with normal or average kidney function. Nephrology clinical practice of today is often adversely affected by peripheral arterial disease diagnostic challenges, all while patients with kidney disease typically tread a slow path to treatment for peripheral arterial disease. For these reasons, a peripheral vascular specialist and nephrologist partnering with one another can have a powerful positive impact on the health and longevity of their patient by addressing underlying causes which may inhibit their ability to get treatment.

How are Kidney Disease and PAD related?

It is vital to understand the pathology of these diseases in order to properly advance both of their treatments. Peripheral arterial disease is a progressive circulatory condition “caused by narrowing and blockages of the arteries, usually in your legs.” This disease affects “approximately 10 million adults in the United States and more than 200 million adults throughout the world,” and is most commonly brought on as a result of atherosclerosis — the build-up of plaque on the inner walls of the artery. However, chronic kidney disease also contributes to atherosclerosis. Atherosclerosis recognized as a “frequent cause of morbidity in patients with end-stage renal disease.”

Moreover, patients dealing with peripheral arterial disease often experience complications, such as a reduction of blood flow to the extremities, which in turn leads to the slowed or stunted healing of wounds. As a result, individuals living with peripheral arterial disease are prone to infections that may ultimately result in the amputation of limbs. Conversely, chronic kidney disease manifests itself in the form of reduced kidney function.

Risk Factors and Population Trends

Classic risk factors of peripheral arterial disease, such as age, smoking, diabetes, hypertension, and hyperlipidemia are incredibly common in patients with kidney disease. And the presence of peripheral arterial disease in patients “is a strong independent risk factor for increased cardiovascular disease mortality and morbidity, including limb amputation” in individuals with chronic kidney disease. On the other hand, kidney disease also “imposes additional unique risk factors that promote arterial disease,” like “chronic inflammation, hypoalbuminemia, and a pro-calcific state.”

The presence of peripheral arterial disease in individuals afflicted by chronic kidney disease “markedly increases the short term risk of heart attack and stroke, and serves as the key cause of limb loss and mortality, with such rates being much greater than that of the general population.” And the prevalence of both symptomatic (i.e., intermittent claudication and critical limb ischemia) and asymptomatic peripheral arterial disease is greater in individuals with chronic kidney disease, in comparison to the general population as well. In order to properly detect peripheral arterial disease, “health care providers should be aware of the importance of evaluating feet, especially when patients have any symptoms or signs indicative” of peripheral arterial disease. Nevertheless, regular screenings are necessary as many peripheral arterial disease patients are asymptomatic.

As of 2014, the prevalence of peripheral arterial disease amongst American individuals was high, afflicting nearly 4.3% “of the general adult population over 40 years of age.”  Moreover, peripheral arterial disease rates are often significantly higher in patients with chronic kidney disease, specifically end-stage renal disease, who require dialysis.

Additionally, in a 2005 study conducted by the joint efforts of researchers at Johns Hopkins, Duke University, and the University of Minnesota that examined more than 14,000 patients over an average timespan of about 14 years, it was found that patients with chronic kidney disease developed peripheral arterial disease at nearly double the speed of those without chronic kidney disease. This allowed these researchers to confidently conclude that patients with chronic kidney disease are, in fact, at a higher risk for peripheral arterial disease.

There are many hurdles that come along with managing to serious comorbid diseases. Individuals with chronic kidney disease “are less likely to be provided recommended ‘optimal’ PAD care,” but nephrologists can serve as a force for positive change.

Overall, peripheral arterial disease continuously goes undiagnosed and untreated, making it one of the “potent risk markers for cardiovascular morbidity and mortality in patients with kidney disease”. The widespread presence of peripheral arterial disease, combined with the “significant mortality, morbidity, and quality-of-life reduction associated with both diseases,” shines a light on the unavoidable need for nephrologists around the world to comprehend the prospective advantages of both early diagnosis and dynamic management of both diseases. However, although early detection and treatment are imperative to avoiding infections and amputations and to achieving the best outcomes for patients, it is vital to note that “nearly half of all peripheral arterial disease patients have no apparent symptoms, it can be very difficult to know if someone has the disease.”

Nephrologists and Cardiologists make a great Care Team

The teaming up nephrologists and peripheral vascular specialists is the clearest route to more accurate, higher-quality treatment for patients that are affected by both chronic kidney disease and peripheral arterial disease. According to the American Journal of Kidney Diseases, “aggressive risk-factor modification, including treatment of diabetes, hyperlipidemia, and hypertension and smoking cessation, should be mandatory in all patients.” The American Journal of Kidney Diseases also strongly recommends that future investigation be completed to properly evaluate the benefit of “earlier treatment strategies” within the population of chronic kidney disease patients, who are often at high risk for cardiovascular diseases like peripheral arterial disease. Early detection of asymptomatic peripheral arterial disease in patients with chronic kidney disease may also “improve both patient and clinician awareness of the potential significance of future exertional leg symptoms or signs of more advanced” peripheral arterial disease. By working together to increase early-stage detection and care, as well as to better understand how to properly treat the two comorbid diseases concurrently, nephrologists and peripheral vascular specialists worldwide may hope to bring better care and quality of life to their patients.