Prevalence and clinical correlates of peripheral artery disease in patients undergoing hemodialysis: a cross-sectional study from Palestine

BACKGROUND: Peripheral artery disease (PAD) is a common but underrecognized complication among patients with end-stage renal disease (ESRD) receiving hemodialysis. PAD contributes substantially to morbidity and mortality, yet data from Palestine are lacking. This study aimed to estimate the prevalence of PAD and examine its association with clinical and laboratory characteristics in hemodialysis patients. METHODS: A cross-sectional study was conducted between February and November 2023 at the dialysis center in a large tertiary accredited teaching hospital, the main referral center in the northern West Bank, Palestine. A total of 278 patients undergoing regular hemodialysis were enrolled. PAD was diagnosed using the ankle–brachial index (ABI) measured by handheld Doppler ultrasound; ABI ≤ 0.90 indicated PAD. Demographic, clinical, and laboratory data were collected from patient interviews and medical records. Multivariable logistic regression was used to identify factors associated with PAD and to estimate adjusted odds ratios with 95% confidence intervals. RESULTS: PAD was detected in 150 of 278 patients (54%). The mean age was 57 ± 16 years, and 176 (63.3%) were male. Hypertension was present in 236 (84.9%), diabetes mellitus in 147 (52.9%), and cardiac disease in 85 (30.6%). PAD was significantly associated with older age (p = 0.01), longer dialysis duration (p = 0.03), hypertension (p = 0.025), diabetes (p = 0.023), cardiac disease (p = 0.008), and lower serum phosphorus levels (p = 0.03). No significant associations were observed with gender (p = 0.448), smoking (p = 0.836), prior myocardial infarction (p = 0.074), stroke (p = 0.170), physical activity (p = 0.688), vascular access type (p = 0.688), duration of hypertension (p = 0.281), or duration of diabetes (p = 0.165). In a multivariable logistic regression model, dialysis duration remained significantly associated with PAD (adjusted OR 1.08 per year, 95% CI 1.01–1.16, p = 0.031). CONCLUSIONS: PAD prevalence was high among hemodialysis patients in this Palestinian cohort, and longer dialysis duration emerged as a significant correlate of PAD. Routine ABI screening—particularly in patients with longer dialysis vintage—may enable earlier detection and management of PAD, potentially reducing adverse cardiovascular outcomes. Further longitudinal studies are warranted to identify causal pathways and inform preventive strategies.