Wattanakit Keattiyoat, Folsom Aaron R, Selvin Elizabeth, Coresh Josef, Hirsch Alan T, Weatherley Beth D
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 South Second Street, Minneapolis, MN 55454-1015, USA.
J Am Soc Nephrol. 2007 Feb;18(2):629-36. doi: 10.1681/ASN.2005111204. Epub 2007 Jan 10.
Chronic kidney disease (CKD) is associated with an increased risk for cardiovascular disease, but its association with peripheral arterial disease (PAD) is unclear. With the use of data from the Atherosclerosis Risk in Communities (ARIC) Study, 14,280 middle-aged adults were categorized on the basis of estimated GFR >/=90, 60 to 89, and 15 to 59 ml/min per 1.73 m(2) for normal kidney function, mildly decreased kidney function, and stages 3 to 4 CKD, respectively. Incident PAD was defined as a new onset of ankle-brachial index <0.9 assessed at regular examinations, new intermittent claudication assessed by annual surveillance, or PAD-related hospital discharges. Incidence rates and relative risks (RR) for PAD were compared across these categories. During a mean follow-up time of 13.1 yr (186,616 person-years), 1016 participants developed PAD. The incidence rates per 1000 person-years were 4.7, 4.9, and 8.6 for the normal kidney function, mildly decreased kidney function, and CKD groups, respectively. Compared with participants with normal kidney function, the age-, gender-, race-, and ARIC field center-adjusted RR for PAD was 1.04 (95% confidence interval [CI] 0.91 to 1.18) for those with mildly decreased kidney function and 1.82 (95% CI 1.34 to 2.47) for those with CKD. After additional adjustment for cardiovascular disease risk factors, an increase in risk for incident PAD still was observed in participants with CKD, with a multivariable adjusted RR of 1.56 (95% CI 1.13 to 2.14). Patients with CKD are at increased risk for incident PAD. Development of strategies for screening and prevention of PAD in this high-risk population seems warranted.
慢性肾脏病（CKD）与心血管疾病风险增加相关，但其与外周动脉疾病（PAD）的关联尚不清楚。利用社区动脉粥样硬化风险（ARIC）研究的数据，14280名中年成年人根据估算的肾小球滤过率（GFR）进行分类，分别为每1.73平方米体表面积肾小球滤过率≥90、60至89以及15至59毫升/分钟，对应正常肾功能、轻度肾功能减退和3至4期CKD。新发PAD定义为定期检查时踝臂指数<0.9的新发情况、年度监测评估的新间歇性跛行或与PAD相关的住院出院。比较了这些类别中PAD的发病率和相对风险（RR）。在平均13.1年的随访时间（186616人年）内，1016名参与者发生了PAD。正常肾功能、轻度肾功能减退和CKD组每1000人年的发病率分别为4.7、4.9和8.6。与肾功能正常的参与者相比，肾功能轻度减退者发生PAD的年龄、性别、种族和ARIC现场中心校正RR为1.04（95%置信区间[CI]0.91至1.18）；CKD患者为1.82（95%CI 1.34至2.47）。在进一步调整心血管疾病危险因素后，仍观察到CKD参与者发生PAD的风险增加，多变量校正RR为1.56（95%CI 1.13至2.14）。CKD患者发生PAD的风险增加。在这一高危人群中制定PAD筛查和预防策略似乎是必要的。
