The Impact of Chronic Kidney Disease on Peripheral Artery Disease and Peripheral Revascularization
Raffaele Serra, Umberto Marcello Bracale, Nicola Ielapi, Luca del Guercio, Maria Donata Di Taranto, Maurizio Sodo, Ashour Michael, Teresa Faga, Egidio Bevacqua, Federica Jiritano, Giuseppe Filiberto Serraino, Pasquale Mastroroberto, Michele Provenzano, Michele Andreucci
Abstract
Chronic kidney disease (CKD) is a clinical condition characterized by high morbidity and mortality. Globally, CKD is also increasing in prevalence and incidence. The two principal kidney measures namely estimated glomerular filtration rate (eGFR) and albuminuria have been found to be predictors of renal and cardiovascular (CV) endpoints including peripheral artery disease (PAD). The prevalence of PAD was increased in CKD patients and, particularly, in patients with more severe CKD stages. Despite the fact that revascularization strategies are suitable in CKD patients in similar fashion to non-CKD patients, few CKD patients underwent these procedures. In fact, if it is true that revascularization improves prognosis in PAD patients irrespective of baseline eGFR, it was also demonstrated that CKD patients, who underwent revascularization, were at higher risk for amputations, mortality, re-intervention and perioperative complications. With the present review article, we have examined the association between CKD, PAD and peripheral revascularization highlighting data about epidemiology, pathophysiologic mechanisms, and results from previous observational and intervention studies. We have also examined the future perspectives and challenges of research around the association between CKD and PAD.