Peripheral Arterial Disease Outcome in Patients with ESRD on Hemodialysis: A Study from a Developing Country

BACKGROUND: End-stage renal disease (ESRD) patients on hemodialysis are at higher risk for cardiovascular complications due to the increased risk of atherosclerosis. This study aims to evaluate the factors associated with poor outcomes in this group of patients with Peripheral arterial disease (PAD) regarding survival and rates of lower limb amputation, which is an important determinant of morbidity and quality of life. METHODS: A retrospective analysis was performed using hospital databases from 2010 to 2021. ESRD patients who were diagnosed with PAD during this period were studied; diagnosis was done through CT-angiography. Predefined endpoints were death and amputation. RESULTS: The mean age for the patients was 65.9 (SD 12.96) and 66.7% were males. Most patients had either DM (84.6%) or HTN (91%). The prevalence of amputation was 44.7%, 32.9% were males (P=0.33); using univariate analysis DM was a strong predictor for amputation (P=0.001) as long as coronary artery disease (P=0.001) while other comorbidities like HTN (P=0.66), heart failure (P=0.86), atrial fibrillation (P=0.81), Dyslipidemia (P=0.95) and stroke (P=0.16) were not associated with amputation. On multivariate analysis, only DM (P=0.003) was associated with a higher prevalence of amputation Time to death was 16.9 months (SDܸ25.6), 11.3 months (SDܸ9.1) for patients with amputation vs. 21.1 (SDܸ32.7) for those without amputation. CONCLUSION: End-stage renal disease patients with PVD, especially with PVD, have higher mortality, and the majority are diabetic, which necessitates earlier recognition of PVD and modified risk factors like better control of DM and its complications in addition to other risk factors like HTN, dyslipidemia, and metabolic disorders of CKD.