Peripheral Artery Disease and CKD: A Focus on Peripheral Artery Disease as a Critical Component of CKD Care
Peripheral Artery Disease and CKD: A Focus on Peripheral Artery Disease as a Critical Component of CKD Care
复制标题
DOI：
10.1053/j.ajkd.2012.02.340
复制
发表时间：
2012-10-01
影响因子：
13.2
通讯作者：
Hirsch, Alan T.
中科院分区：
文献类型：
--
作者：
Garimella, Pranav S.;Hart, Peter D.;Hirsch, Alan T.
外周动脉疾病（PAD）在慢性肾脏病（CKD）患者中的发病率高于一般人群。PAD是CKD患者心血管疾病死亡率和发病率（包括截肢）增加的一个强独立风险因素。在没有典型间歇性跛行或存在非典型腿部症状的情况下，CKD患者的PAD诊断可能具有挑战性。此外，足动脉不可压缩性可能会降低踝肱指数测量的准确性，踝肱指数是最常见的PAD诊断工具。如果踝臂指数值正常但临床怀疑仍存在，则应使用其他方法，如趾臂指数。积极的风险因素调整，包括糖尿病、高脂血症、高血压和戒烟的治疗，应该是所有患者的强制性措施。所有PAD患者的治疗应包括抗血小板药物和处方监督运动计划和/或西洛他唑用于跛行症状的患者。预防性足部护理措施和涉及足科医生和血管和伤口护理专家的多学科方法应用于减少截肢。严重肢体缺血的血运重建与CKD伴PAD患者的不良结局相关。建议进一步研究以评估早期治疗策略在这一高心血管疾病风险CKD人群中的获益。美国肾脏病杂志60（4）：641-654。(C)2012年，美国国家肾脏基金会（National Kidney Foundation，Inc.）爱思唯尔公司出版All rights reserved.
The incidence of peripheral artery disease (PAD) is higher in patients with chronic kidney disease (CKD) than in the general population. PAD is a strong independent risk factor for increased cardiovascular disease mortality and morbidity, including limb amputation, in persons with CKD. Diagnosis of PAD in patients with CKD may be challenging in the absence of classic intermittent claudication or the presence of atypical leg symptoms. In addition, pedal artery incompressibility may decrease the accuracy of ankle-brachial index measurement, the most common PAD diagnostic tool. Alternative methods such as toe-brachial index should be used if clinical suspicion persists despite a normal ankle-brachial index value. Aggressive risk-factor modification, including treatment of diabetes, hyperlipidemia, and hypertension and smoking cessation, should be mandatory in all patients. Treatment of all individuals with PAD should include antiplatelet medications and prescribed supervised exercise programs and/or cilostazol for individuals with claudication symptoms. Preventive foot care measures and a multidisciplinary approach involving podiatrists and vascular and wound care specialists should be used to reduce amputations. Revascularization for critical limb ischemia is associated with poor outcomes in patients with CKD with PAD. Future investigation is recommended to evaluate the benefit of earlier treatment strategies in this high cardiovascular disease risk population with CKD. Am J Kidney Dis. 60(4):641-654. (C) 2012 by the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.