Asymptomatic peripheral artery disease and mortality in patients on hemodialysis

Abstract

Background: Asymptomatic peripheral artery disease (PAD) increases the risk of mortality in non-hemodialysis patients. However, the association between asymptomatic PAD and mortality rate remains unclear in patients on hemodialysis. Methods: This retrospective cohort study aimed to assess the prognostic significance of asymptomatic PAD in a population of 310 hemodialysis patients. Patients with an ankle-brachial index of < 1.00, or > 1.40 with a toe-brachial index of < 0.70, were diagnosed as having PAD. The San Diego Claudication Questionnaire was used to characterize leg symptoms in patients with PAD, and asymptomatic PAD was defined as the absence of symptoms in the legs or buttocks while walking. The mortality risk of asymptomatic PAD was assessed using the Cox proportional hazard model. Results: The rate of PAD was 28.1%. Among 87 patients, those with PAD, 66.7% were asymptomatic. Fifty-eight patients died during a mean follow-up of 38.9 months. Multivariate analysis revealed hazard ratios of 1.963 (95% confidence interval (CI), 1.012 to 3.740; P = 0.046) and 3.237 (95% CI, 1.402 to 7.020; P = 0.007) in patients with asymptomatic PAD and symptomatic PAD, respectively, compared to patients without PAD. No significant difference was observed between patients with asymptomatic PAD and symptomatic PAD in terms of survival. Conclusions: Hemodialysis patients with asymptomatic PAD have an elevated mortality risk compared to patients without PAD, with no significant difference compared to patients with symptomatic PAD.