Association and clinical relevance of absence of lower limb arterial pulse and coronary artery disease in hemodialysis patients

Objectives: To determine the association between PAD and DAC in patients treated by haemodialysis in the waiting list for renal transplantation and to assert the influence of that association on prognosis and clinical management. Methods: 1246 renal transplant candidates underwent coronary angiography. Peripheral artery disease was defined as either absence of pulse in the lower limb or a history of gangrene, amputation, or vascular intervention. Results: The prevalence of peripheral artery disease and coronary artery disease were 34% and 52%, respectively. The association of peripheral artery disease with coronary artery disease was significant (68% versus 32%, OR = 2.60, 95% CI 2.03–3.32, P = .0001). The specificity, sensitivity, positive predictive value, and negative predictive value were 77%, 44%, 67%, and 56%, respectively. Peripheral artery disease predicted the indication of coronary intervention. Patients lacking peripheral artery disease and coronary artery disease enjoyed higher event-free survival. Peripheral artery disease and coronary artery disease together did not add to the very high cardiovascular risk associated with each isolated condition. Death by any cause was influenced by peripheral artery disease independently of coronary artery disease. Conclusions: A safe and inexpensive clinical method was useful to assess the association between PAD and CAD and may be useful to select patients for invasive studies. PAD was equivalent to CAD as a predictor of cardiovascular prognosis. Combining coronary and PAD evaluation helps to assess the prognosis of patients with CKD with reasonable accuracy.