Prevalence of intermittent claudication and risk factors for its development in patients on renal replacement therapy.

The prevalence of symptomatic intermittent claudication (IC) was assessed using a standard cardiovascular questionnaire in a cohort of 325 patients on renal replacement therapy (RRT). IC was found in 19% of patients, 77% of whom were smokers and 22% diabetic. It was more common in men than women and in smokers than non-smokers (p < 0.001). Those with IC were significantly older (61 years vs. 50 years p < 0.001), smoked more (23 pack years vs. 12 pack years p = 0.002), had higher median systolic blood pressures (143 mmHg vs. 140 mmHg p = 0.041) and median triglyceride levels (2.07 mmol/l vs. 1.60 mmol/l p = 0.023) than those renal patients without IC. A case control study matching for age, sex and treatment revealed patients with IC to have higher median systolic blood pressure (147 mmHg vs. 140 mmHg p = 0.031), cholesterol (6.70 mmol/l vs. 5.90 mmol/l p = 0.029), LDL cholesterol (4.64 mmol/l vs. 3.86 mmol/l p = 0.011), and contained a greater proportion of smokers (78% vs. 50% p < 0.001). IC is common in patients on RRT. Whilst smoking was prevalent among those with IC it was much less frequent than in the general population with IC. Other factors such as hypertension, lipid abnormalities or the uraemic state itself may also be important in the development of IC in these patients.

Prevalence of symptomatic arterial disease and risk factors for its development in patients on continuous ambulatory peritoneal dialysis.

The prevalence of coronary, cerebral, and peripheral arterial disease was assessed using a standard cardiovascular questionnaire in a cohort of 70 patients on continuous ambulatory peritoneal dialysis (CAPD). Symptomatic vascular disease was found in 47% of patients, 72% of whom were smokers and 30% diabetic. In 39% of these patients vascular disease was evident prior to the commencement of peritoneal dialysis. A case control study matching for age and sex revealed patients with vascular disease to have higher median systolic blood pressure (162 mmHg vs 150 mmHg, p = 0.026), cholesterol (6.60 mmol/L vs 6.00 mmol/L, p = 0.014), and LDL cholesterol (4.80 mmol/L vs 3.80 mmol/L, p = 0.009). Vascular disease is common in patients on peritoneal dialysis, a considerable proportion of whom have the disease prior to the commencement of dialysis. Elevated systolic blood pressure and hypercholesterolemia, but not smoking, are most closely associated with vascular disease in these patients.