24% of Chronic Kidney Disease (CKD) patients also have Peripheral Arterial Disease (PAD)
Chronic Kidney Disease is an independent risk factor for the development of PAD, along with other cardiovascular risk factors (smoking, hypertension, diabetes, and overweight). On the other hand, cardiovascular diseases are also a major risk factor for the development of CKD. In fact, these two diseases have exactly the same major risk factors.
Because both diseases are caused by the same factors, it is extremely important to diagnose PAD on any patient that are in the risk group. Patients with CKD have a much higher risk of developing PAD (risk increasing with worsening of kidney functions), that is why it is important that blocked arteries are diagnosed in the early stage.
Ankle-Brachial Index Measurement
Diagnosis of Peripheral Arterial Disease (PAD) starts with Ankle-Brachial Index (ABI) measurement. If the patients are in the cardiovascular risk group, they must get their ABI measured (ESC guidelines, 2017) and in case that patients have Chronic Kidney Disease – all patients on dialysis should be all the time evaluated for PAD (KDOQI guidelines).
Ankle-Brachial Index measurement is a very important measurement for diagnosis of any blockages in the arteries, not only at the vascular department but for example in case of CKD, at nephrology department and dialysis centres. ABI can be a quite complicated measurement to perform when using the golden standard – manual Doppler probe, but with an automated ABI measuring device, the measurement becomes fast, extremely accurate and very simple to perform. New technology makes it possible for the medical professionals, to measure ABI on all patients on dialysis and still have enough time to focus on their primary disease.
The importance of ABI measurement by Prof. Dr. Bojan Knap, MD, Spec. in Internal Medicine
“Vascular diagnostics, especially non-invasive, can be the foundation for better management of vascular diseases in patients with chronic renal disease as well as in patients with end-stage renal disease receiving replacement therapy. Due to the common peripheral vascular obstructive disease affecting the legs, the ankle-brachial index is an excellent diagnostic tool to monitor vascular condition and for further diagnosis and therapy both in terms of non-pharmacological (lifestyle) and pharmacological treatment.“
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References:
1. Aboyans, V., Ricco, J., Bartelink, M., Bjorck, M., Brodmann, M., Cohnert, T., Collet, J., Czerny, M., De Carlo, M., Debusa, S., Espinola-Klein, C., Kahan, T., Kownator, S., Mazzolai, L., Naylora, A., Roffi, M., Rotherb, J., Sprynger, M., Tendera, M., Tepe, G., Venermoa, M., Vlachopoulos, C. and Desormais, I. (2018). 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Revista Española de Cardiología (English Edition), 71(2), p.111.
2. DeLoach, S. and Mohler, E. (2007). Peripheral Arterial Disease: A Guide for Nephrologists. Clinical Journal of the American Society of Nephrology, 2(4), pp.839-846.
3. Garimella, P. and Hirsch, A. (2014). Peripheral Artery Disease and Chronic Kidney Disease: Clinical Synergy to Improve Outcomes. Advances in Chronic Kidney Disease, 21(6), pp.460-471.
4. K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients. (2005). American Journal of Kidney Diseases, 45, pp.16-153.