Matsushita K et al. – This study evaluated the independent and joint associations of estimated glomerular filtration rate (eGFR) and albuminuria in chronic kidney disease (CKD) with the incidence of peripheral artery disease (PAD). Results indicated that even mild to moderate CKD is associated with an increased risk of incident PAD with a strong association between albuminuria and amputation. Patients with any stage of CKD should be closely monitored for the development of PAD symptoms and signs.

Methods

• A collaborative meta–analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium analyzed data from 817,084 patients (enrolled in 21 cohorts between 1972 and 2014) without a history of PAD at baseline.
• For patients without PAD at baseline, Cox proportional hazards models were used to determine associations of creatinine–based eGFR, urine albumin–to–creatinine ratio (ACR), and dipstick proteinuria with the incidence of PAD, including hospitalization with a diagnosis of PAD, intermittent claudication, leg revascularization, and leg amputation.
• Discrimination improvement was evaluated using c–statistics.

Results

• During a median follow–up of 7.4 years across cohorts, 18,261 cases of PAD were recorded.
• Both eGFR and albuminuria were independently associated with the incidence of PAD.
• Furthermore, both eGFR and urine ACR significantly improved the risk of PAD beyond traditional predictors; amputation predictions with ACR were improved.
• Patterns were consistent across clinical subgroups.