Peripheral artery disease at the time of dialysis initiation and mortality: a prospective observational multicenter study.

ABSTRACT

OBJECTIVES: Patients with peripheral artery disease (PAD) are reported to have a poorer prognosis than those without PAD. PAD is sometimes found at dialysis initiation, but its influence on the prognosis in these patients has not been investigated. We aimed to compare the mortality rate between patients with PAD at the time of dialysis initiation and those without PAD. DESIGN: We undertook an observational prospective multicenter study of patients starting dialysis treatment. Data were collected on patients' sex, age, presence of PAD, medication, medical history and clinical and laboratory data. SETTING: Seventeen centers participated in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis. PARTICIPANTS: A total of 1524 patients with chronic kidney disease started dialysis from October 2011 to September 2013. The patients were followed-up until March 2015. During this time, there were two patients who lost the follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was defined as all-cause mortality. The secondary outcomes were defined as each cause of mortality. RESULTS: This study included 1030 men and 492 women with a mean age of 67.50±13.10 years. Of these, 71 had PAD and 1451 did not have PAD. After a median follow-up of 814.5 days, 33.80% of the former group and 17.00% of the latter group had died in March 2015 (p=0.001). After adjusting for confounding factors, PAD at dialysis initiation remained an independent risk factor for mortality (p<0.01). CONCLUSIONS: Patients with PAD at the time of dialysis initiation had a poorer prognosis than patients without PAD. Therefore, the presence of PAD in patients starting dialysis should be considered for their monitoring and follow-up.