Key result
PAD diagnosed by pulse palpation is linked to higher risk of major cardiovascular events.
Why the study?
Simple, inexpensive, and reliable noninvasive testing is needed to predict CAD in patients with CKD, who have elevated cardiovascular events and mortality.
Does peripheral artery disease diagnosed by pulse palpation predict coronary artery disease and cardiovascular events in patients with stage 5 chronic kidney disease on hemodialysis?
Cohort (n=201)
No
Does peripheral artery disease diagnosed by pulse palpation predict coronary artery disease and cardiovascular events in patients with stage 5 chronic kidney disease on hemodialysis?
p-value: p=0.024
Simple pulse palpation is a reliable clinical tool that effectively predicts severe coronary artery disease and future cardiovascular events in high-risk dialysis patients.
PAD by palpation was associated with higher event risk in dialysis patients; leaves open its added value for CAD prediction or risk stratification.
There is a need of simple, inexpensive, and reliable noninvasive testing to predict coronary artery disease (CAD) in patients with chronic kidney disease (CKD), where the prevalence of cardiovascular (CV) events and death is elevated. We analyzed the association between peripheral artery disease (PAD) and CAD in 201 patients with stage 5 CKD on dialysis using a prospective observational cohort. Diagnosis of PAD by both palpation and USD were significantly correlated. In patients with PAD diagnosed by palpation, CAD was observed in 80%, while in those diagnosed by USD, CAD was present in 79.1%. The absence of a pulse by palpation predicted CAD with a sensitivity of 55% and a specificity of 76%; USD showed a sensitivity of 62% and specificity of 60% to predict CAD. The risk of combined serious CV events and death was significantly higher in subjects with PAD diagnosed by palpation, but not by USD. PAD assessed by palpation also correlated with the occurrence of multivessel CAD and with the probability of coronary intervention. Both methods are moderately useful for predicting CAD, but PAD diagnosis by palpation was a better predictor of combined CV events and death and was also associated with CAD severity and likelihood of intervention.
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Santos et al. (2023) conducted a cohort in Stage 5 chronic kidney disease on hemodialysis (n=201). Peripheral artery disease diagnosed by pulse palpation vs. Absence of peripheral artery disease by pulse palpation was evaluated on Composite incidence of major cardiovascular events (myocardial infarction, unstable angina, sudden death, stroke, peripheral vascular event, or new-onset heart failure) (p=0.024). Peripheral artery disease diagnosed by pulse palpation was associated with a significantly higher cumulative risk of combined cardiovascular events (p=0.024) and all-cause mortality (p<0.001).
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