March is National Kidney Month, so we’re taking the time to spread awareness about Chronic Kidney Disease (CKD). This is especially important to note as people with CKD are at a higher risk of developing peripheral artery disease (PAD) and its adverse health outcomes than individuals with normal renal function.
Caused by narrowing and blockages in the arteries in your legs, PAD is a progressive condition most commonly due to atherosclerosis, which is an accumulation of plaque on the inner walls of the artery.1 CKD also contributes to atherosclerosis.2
How Peripheral Artery Disease & Chronic Kidney Disease are Related
CKD is characterized by reduced kidney function, while PAD is characterized by reduced blood flow to the extremities, particularly the legs. This can potentially cause wounds to heal slowly or not at all.
Reportedly, there’s evidence suggesting CKD patients are at an increased risk of developing atherosclerosis and other cardiovascular diseases. With atherosclerosis as the common denominator, it has become more apparent that there could be a link between PAD & CKD in the form of an increased risk.4 However, until recently, there was little research on their possible correlation.
According to researchers, it appears that patients with CKD have an increased risk of developing PAD.4
Additionally, CKD and PAD share some notable risk factors like diabetes, high blood pressure, and 60+ age. The prevalence of PAD in patients with chronic kidney disease is higher than the prevalence of heart attack and stroke in CKD patients.4
Renal Failure & Contrast
Although contrast dyes are generally safe for most patients, those with renal failure may be at additional risks of developing contrast-induced nephropathy (CIN) a rare disorder that occurs when kidney problems are caused by the use of certain contrast dyes.
In most cases contrast dyes used in tests, such as CT and angiograms, have no reported problems, with only 2% of people receiving dyes can develop CIN. That being said, the risk for CIN can increase for people with diabetes, a history of heart and blood diseases, and CKD.4
Modern Vascular uses minimal contrast and we have a CO2 option for renal patients in order to carefully evaluate patients while being cognizant of the risks associated with reduced kidney function.
Screening for PAD
Since roughly half of PAD patients have no apparent symptoms, it’s difficult at times to know if someone has the disease,1 making early detection and treatment of PAD that much more important to stay on top of. It’s imperative to avoid infections and prioritize treatment to avoid the necessity of amputation.
Patients who have chronic kidney disease should undergo evaluation, even if they show no symptoms of peripheral artery disease.
In order to screen for PAD several imaging tests are used to diagnose and evaluate PAD:
- Vascular ultrasound
- Doppler ultrasound
- Catheter angiography
- CT angiography (CTA)
- MR angiography (MRA)
Your Healthcare Team
Patients with both CKD and PAD should have healthcare providers from several specialties working in cooperation on their care. According to doctors in a 2015 paper, it is recommended that patients with PAD-CKD be managed by a multidisciplinary team including the following specialists: vascular specialists, nephrologists (kidney experts) and wound care specialists.3
Even with a great team, the role the patient plays in their own healthcare is crucial. If you have CKD it’s always a good idea to get checked for PAD even if you aren’t experiencing any PAD symptoms and asking your team for more information about your risks. Keep your entire healthcare team up to date on your health history, including your current medications and any new or changing symptoms.
It is also important to adhere to a healthy diet, exercise regularly (we recommend walking), avoid smoking and drinking excessive alcohol. Finally, always follow the advice of your healthcare providers and take any medications as prescribed.
- Johns Hopkins. Peripheral Vascular Disease. (accessed 3/18/2021)
- Kon, V., Linton, M. & Fazio, S. Atherosclerosis in chronic kidney disease: the role of macrophages. Nat Rev Nephrol 7, 45–54 (2011). https://doi.org/10.1038/nrneph.2010.157
- Garimella, P.S., Hirsch, A.T. “Peripheral Artery Disease and Chronic Kidney Disease: Clinical Synergy to Improve Outcomes.” Adv. Chronic Kidney Dis., 2014. 21(6): p. 460-471
- National Kidney Foundation “Contrast Dye and the Kidneys” Accessed (3/18/2021)