Impact of Lower Limbs' Arterial Calcification on the Prevalence and Severity of PAD in Patients on Hemodialysis

Background: Peripheral arterial disease (PAD) is one of the serious complications in patients on hemodialysis (HD) therapy. However, arterial calcification of lower limbs' arteries and its impact on the prevalence and severity of PAD has never been quantitatively evaluated in HD patients with PAD.

Methods: Ninety-seven HD patients were enrolled to evaluate calcification score in superficial femoral artery (SFACS) and below-knee arteries (BKACS) quantitatively by 64-row multidetector computed tomography as well as ankle-brachial pressure index (ABI), toe-brachial pressure index (TBI), and clinical and laboratory parameters.

Results: Forty-six patients (47.2%) had PAD, and 11 patients had critical limb ischemia (CLI). SFACS and BKACS were significantly associated with the prevalence and severity of PAD, and receiver-operating characteristic analysis showed that SFACS and BKACS well predicted the prevalence of PAD and CLI in HD patients. The independent associating factors for PAD were BKACS and low TBI (r(2) = 0.534; P < .0001). Low TBI was also an independent associating factor for CLI (r(2) = 0.245; P < .0001). Multivariate analysis indicated that the independent associating factors for TBI in HD patients were BKACS and C-reactive protein (CRP; r(2) = 0.358; P = .006).

Conclusions: Present quantitative analysis clearly provided the first evidence that arterial calcification of lower limbs' arteries was closely associated with the prevalence and severity of PAD in HD patients. Furthermore, arterial calcification of below-knee arteries and micro-inflammation represented as CRP were the independent associating factors for low TBI, which was the independent associating factor for PAD and CLI in HD patients.