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Review
. 2014 Nov;21(6):460-71.
doi: 10.1053/j.ackd.2014.07.005. Epub 2014 Oct 24.

Peripheral artery disease and chronic kidney disease: clinical synergy to improve outcomes

Pranav S Garimella  1 , Alan T Hirsch  2
Affiliations
Review

Peripheral artery disease and chronic kidney disease: clinical synergy to improve outcomes

Pranav S Garimella et al. Adv Chronic Kidney Dis. 2014 Nov.

Abstract

Persons with CKD are at a higher risk of developing peripheral artery disease (PAD) and its adverse health outcomes than individuals in the general population who have normal renal function. Classic atherosclerosis risk factors (eg, age, smoking, diabetes, hypertension, and hyperlipidemia) are common in patients with CKD, but CKD also imposes additional unique risk factors that promote arterial disease (eg, chronic inflammation, hypoalbuminemia, and a procalcific state). Current nephrology clinical practice is adversely affected by PAD diagnostic challenges, the complexities of managing 2 serious comorbid diseases, delayed vascular specialist referral, and slow PAD treatment initiation in patients with CKD. Persons with CKD are less likely to be provided recommended "optimal" PAD care. The knowledge that both limb and mortality outcomes are significantly worse in patients with CKD, especially those on dialysis, is not just a biologic fact but can serve as a care delivery call to action. Nephrologists can facilitate positive change. This article proposes that patients with PAD and CKD be strategically comanaged by care teams that encompass the skills to create and use evidence-based care pathways. This proposed collaborative multidisciplinary approach will include vascular medicine specialists, nephrologists, wound specialists, and mid-level providers. Just as clinical care quality metrics have served as the base for ESRD and acute MI quality improvement, it is time that such quality outcomes metrics be initiated for the large PAD-CKD population. This new system will identify and resolve key gaps in the current care model so that clinical outcomes improve within a cost-effective care frame for this vulnerable population.

Keywords: Clinical outcomes; Collaborative care; Kidney disease; Multidisciplinary teams; Peripheral artery disease.

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Conflict of interest statement

Conflict of interest statement: Pranav S. Garimella: none

Figures

Figure 1
Figure 1
ACC-AHA PAD Guideline algorithm defining the key clinical PAD syndromes that define subsequent care pathways.
Figure 2
Figure 2
The ACC-AHA PAD Guideline for the assessment of claudication and systemic risk.
Figure 3
Figure 3
The ACC-AHA PAD Guideline algorithm for the treatment of claudication.
See this image and copyright information in PMC

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