| Background and Objective :As the technology and quality of hemodialysis has been improved, more and more patients in chronic kidney disease(chronic kidney disease, CKD) progress to end-stage renal disease(end-stage renal disease, ESRD) and finally to renal replacement therapy. Due to prolonged lifespan, patients have been suffering from many complications. Among them, the incidence rate of peripheral artery disease in patients with ESRD(peripheral artery disease, PAD) is higher than that of normal subjects, and the risk of amputation and mortality rate is increasing, which is serious harm to health and quality of life in patients with ESRD. In addition, K/DOQI guidelines suggests that patients at the beginning of renal replacement therapy should be screened for PAD. Until now, there are many studies of PAD risk factors in CKD patients. But little data is available about factors of PAD in ESRD patients. Therefore, a study was conducted to investigate factors influencing prevalence of PAD by analysis of incidence and related risk factors of PAD in ESRD patients. Materials and Method:A retrospective study was conducted, including 275 patients in our hospital kidney disease blood purification center during 2011-2012 years.Patients were divided into peripheral artery disease(PAD) group and non peripheral artery disease(non-PAD) group according to the ankle brachial index(ankle-brachial index; ABI) and the related risk factors were analyzed. The general data of 275 cases with ESRD, including age, gender, height, weight, history of diabetes, history of hypertension, history of cardiovascular disease, smoking history, and other parameters such as Vitamin D; soluble vascular cell adhesion molecule-1(sICAM-1) and soluble vascular adhesion molecule-1(sVCAM-1) were also analyzed. Follew two years, clinical data of a patient’s complications as well as cause of death were recorded. Application of SPSS 17 statistical software package was used for statistical analysis of all data, P<0.05 had significant difference. Results:①82 patients suffered from PAD among 275 ESRD patients with prevalence of 29.82%.The prevalence of PAD in hemodialysis patients and peritoneal dialysis patients was 37.59% vs 21.64%, which was significant difference(c2=6.646, P=0.01).②The level of age、incidence of diabetes、 history of cardiovascular events、 systolic blood pressure 、 high-sensitivity C-reactive protein(hsCRP) 、 β2-microglobulin(β2-mg)、 homocysteine(Hcy)、soluble vascular cell adhesion molecule-1(sICAM-1) and soluble vascular adhesion molecule-1(sVCAM-1) in PAD group were more higher than that in non-PAD group,while the level of albumin and vitamin D were lower than that in non-PAD group with p-value<0.05. ③During follow up period, 34 patients died in PAD group while 96 patients died in non-PAD group.Among PAD patients, the mortality rate in hemodialysis patients group was higher than that in peritoneal dialysis patients(c2=14.957, P<0.01).④There was lower survival rate in the hemodialysis group with PAD compared with peritoneal dialysis patients with PAD(c2=4.194,P=0.041).However, there was no significant difference of survival rate in in PAD group and non-PAD group.⑤ Furthermore, albumin, triglyceride and ipth were the independent risk factors of mortality for ESRD patients with PAD by Cox regression model. Conclusion:There was high prevalence of PAD in ESRD patients. There was more likelihood of hypoalbumin, metabolic disturbance of calcium and phosphate as well as Dyslipidemia. Meanwhile, patients with PAD in hemodialysis were at risk of high mortality. In addition, the level of soluble vascular cell adhesion molecule-1(sICAM-1) and soluble vascular adhesion molecule-1(sVCAM-1) in PAD paitents were more likely higher than that in non-PAD patients. Positive management of dyslipidemia, metabolic disturbance of calcium and phosphate in combination with improvement of albumin level maybe helpful for outcomes of patients with PAD. |
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