Effects of dialysis on peripheral arterial disease

Abstract

End-stage renal disease is an independent risk factor for the development of peripheral arterial disease, with considerably worse outcomes in patients with concomitant diseases. It is important to realize the widespread, yet frequently asymptomatic, nature of peripheral arterial disease in patients with end-stage renal disease due to the presence of other comorbidities that decrease activity levels and sensation to allow for early recognition and timely medical management to try and mitigate otherwise poor outcomes. Despite their high risk, properly selected patients derive benefit from revascularization; both open and endovascular approaches provide similar outcomes in terms of overall survival, amputation-free survival, and limb salvage, with perhaps a slight preference toward open repair. This narrative review of the literature evaluates the epidemiology, pathophysiology, outcomes, and management strategies that provide the best possible outcomes for patients with peripheral arterial disease and end-stage renal disease.

Keywords: Amputation-free survival; Critical limb-threatening ischemia; End-stage renal disease; Hemodialysis; Peripheral arterial disease.