Did you know that 10% of people worldwide are affected by chronic kidney disease (CKD) and that more than 2 million people worldwide currently receive treatment with dialysis or are waiting for a kidney transplantation?[i]
Patients with chronic kidney disease are at higher risk of cardiovascular diseases, particularly coronary artery disease (CAD), congestive heart failure and peripheral arterial disease (PAD).
Prognosis of PAD in patients with chronic kidney disease (CKD) is not great, and PAD usually coexists with CAD and diabetes. Patients with damaged renal function are twice as likely to develop PAD than the ones with healthy kidneys. Cross-sectional analysis showed that 24% of patients with chronic kidney disease also have PAD.[ii]
Patients on dialysis are at higher risk of getting PAD. Dialysis is necessary for the last of 5 stages of chronic kidney disease, which is kidney failure. The body cannot excrete toxins (serum phosphorus, calcium, proteins) from the blood anymore and these toxins damage peripheral neuropathy which accelerates development of PAD.[iii]
What can physicians do?
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend that patients on dialysis should be monitored for PAD continuously.
Who is responsible for checking patients? – As always primary care clinicians are the ones responsible for identifying high-risk patients for PAD, but in the case of patients with CKD, nephrologists and cardiovascular physicians come into play. In practice, in most cases, the nephrologists are the only physicians to see patients with CKD. So they should be the ones who insist on screening, diagnosis, and treatment for these patients.
Now, back to the start. Why do dialysis centers need an ABI measuring device? Not only because nephrologists are the ones who should be responsible for screening and detecting PAD in CKD patients, but also because patients on dialysis should be checked for PAD all the time while being on dialysis. However, the fact that a very limited number of nephrologists’ practices and dialysis units are equipped for taking these measurements, does not help.
Patients who are on dialysis and have a PAD diagnosis have a 36% higher mortality risk. This argument should be strong enough to make sure that we all contribute to raising awareness of detecting PAD among chronic kidney disease patients, or at least in those who are already on dialysis.
[i] The National Kidney Foundation. (2017). Global Facts: About Kidney Disease. [online] Available at: https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease [Accessed 2 Feb. 2017].
[ii] 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.
[iii] 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.