engleski

Upper Extremity Subclinical Peripheral Arterial Disease in Patients with Chronic Kidney Disease in Predialysis Stage-A Pilot Study

Objectives: this study was designed to determine the prevalence and related risk factors of different types of upper extremities subclinical peripheral arterial disease (occlusive-OPAD and medial arterial calcifications-MAC) in patients with end-stage chronic kidney disease (CKD). Background: combination of lower extremities PAD and CKD is a well known condition, however there are few published data on the prevalence and severity of different types of upper extremities PAD in asymptomatic patients with CKD in predialysis stage. Recent pathobiological studies show that medial MAC is not a passive and degenerative but a dynamic process which change arterial elasticity and share many features with embrionic bone formation. It contributes to increased cardiovascular (CV) risk in this population. The association of MAC and arteriovenous fistula (AVF) postoperative stenosis or non maturation in patients with CKD is not completely understood. Gray-scale ultrasound is a sensitive method for assessment and scoring the magnitude of MAC. Duplex Doppler is a non-invasive method for evaluation of the pattern of distribuition and severity of upper extrmities OPAD. Study design: cross-sectional pilot study. Methods: prevalence of upper extremities MAC and OPAD was investigated in 41 asymptomatic patient with CKD and 18 participants with normal kidney function, using gray-scale B-mode ultrasound and duplex Doppler, according to the Hammersmith Hospital London Vascular Laboratory Protocol. MAC was categorized as none, moderate and severe. OPAD was categorized as none, hamodinamically significant stenosis and occlusion. Results: mild to severe medial arterial calcification in brachial, ulnar and radial arteries was significantly more prevalent in CKD group (P=0.015), while the prevalence of occlusive PAD was not signifacntly different between two groups (P=0.381). Patients in CKD group were somewhat younger and more often female (P=0.038 and 0.081, respectively). Smoking was significantly less prevalent in CKD than in control group (P=0.038). Hyertension was significantly more prevalent in CKD group (0.034). Prevalence of diabetes mellitus was notably higher in CKD than in control group, but the difference was not statistically signficant (0.064). Conclusion: grey scale and duplex Doppler ultrasound screening for different forms of upper extremities subclinical PAD in patients with CKD will contribute to currently non explained possible role of MAC in mechanism of limited vascular dilatation and failure of AVF to mature. Vascular assessment of upper limb OPAD may identify individuals with increased risk for cardiovascular diseases to whom secondary prevention measures may be implemented.

Peripheral artery disease ; Medial arterial calcification ; Vascular ultrasound

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