Peripheral arterial disease in renal transplant patients. Validity of the Edinburgh questionnaire for disease diagnosis
Keywords:
ankle-brachial index; Edinburgh questionnaire; intermittent claudication; peripheral arterial disease; cardiovascular risk
Abstract
Objectives: To assess the prevalence of peripheral artery disease in kidney transplant patients and the validity of intermittent claudication for its diagnosis. Methods: Setting and period: Nephrology Department of the University Hospital A. Coruña, 2013-2017. Inclusion criteria: transplant patients with functioning grafts who gave their consent to participate in the study. Sample size rationale: n=371 patients (confidence interval= 95%; precision= ± 4.25%). Measurements: age, age at the time of transplant, sex, dyslipemia, body mass index, smoking, diabetes, sign of Godet, perimalleolar edema, ankle-brachial index and the Edinburgh Questionnaire. Cardiovascular risk was measured with these scores: Framingham-Wilson, Regicore, SCORE and Dorica. Results: The mean age at the time of transplant was 47.86±12.62; 65.5% of patients were men and 8.7% of them had an ankle-brachial index of <0.90. When answering the Edinburgh Questionnaire, 16.2% of subjects reported suffering from intermittent claudication. Concordance between these two diagnostic tests is poor (kappa index= 0.34). The Edinburgh Questionnaire showed a sensitivity of 59.38% in predicting the ankle-brachial index (<0.90) and specificity (88.10%). The variables associated with the presence of artery disease are age at the time of transplant (OR=1.07) and smoking (OR=6.17), dyslipidemia being at the limit of statistical significance. Conclusions: A tenth part of the patients have peripheral artery disease. Concordance between the Edinburgh Questionnaire and the ankle-brachial index is poor; therefore, the latter should be used as diagnostic method. Clinical signs and symptoms underestimate the prevalence of artery disease. Age, smoking and dyslipidemia increase the risk of this disease. Artery disease patients have a higher cardiovascular risk.
References
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22) Franke GH, Reimer J, Kohnle M, Luetkes P, Maehner N, Heemann U. Quality of life in end-stage renal disease patients after successful kidney transplantation: development of the ESRD symptom checklist - transplantation module. Nephron. 1999;83(1):31-9. doi: 10.1159/000045470.
23) Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol. 1998;9(12 Suppl.):S16-23.
24) Moreno-Carriles RM. Registro de actividad de la Sociedad Española de Angiología y Cirugía Vascular, año 2007. Angiología. 2008;60(4):291-316.
25) Forés R, Alzamora MT, Baena JM, Pera G, Torán P, Ingla J, et al. Infradiagnóstico de la arteriopatía periférica en la población española. Estudio ARTPER. Med Clin (Barc). 2010;135(7):306-9. doi: 10.1016/j.medcli.2009.11.046.
26) Alonso I, Valdivielso P, Zamudio MJ, Sánchez M.A, Pérez F, Ramos H, et al. Rentabilidad del índice tobillo-brazo para la detección de enfermedad arterial periférica en población laboral de la Junta de Andalucía en Málaga. Med Clin (Barc). 2009;132(1):7-11. doi: 10.1016/j.medcli.2008.02.002.
27) Vicente I, Lahoz C, Taboada M, García A, San Martín MA, Terol I, et al. Prevalencia de un índice tobillo-brazo patológico según el riesgo cardiovascular calculado mediante la función de Framingham. Med Clin (Barc). 2005;124(17):641-4. doi: 10.1157/13074738.
28) Ramos R, Quesada M, Solanas P, Subirana I, Sala J, Vila J, et al.; REGICOR Investigators. Prevalence of symptomatic and asymptomatic peripheral arterial disease and the value of the ankle-brachial index to stratify cardiovascular risk. Eur J Vasc Endovasc Surg. 2009;38(3):305-11. doi: 10.1016/j.ejvs.2009.04.013.
29) Carbayo JA, Divisón JA, Escribano J, López-Abril J, López de Coca E, Artigao LM, et al.; Grupo de Enfermedades Vasculares de Albacete (GEVA). Using ankle-brachial index to detect peripheral arterial disease: prevalence and associated risk factors in a random population sample. Nutr Metab Cardiovasc Dis. 2007;17(1):41-9. doi: 10.1016/j.numecd.2005.08.009.
30) Puras Mallagray E. Claudicación: epidemiología e historia natural. Angiología. 2010;62(Esp Cong):52-6.
31) Guindo J, Martínez-Ruíz MD, Gusi G, Punti J, Bermúdez P, Martínez-Rubio A. Métodos diagnósticos de la enfermedad arterial periférica. Importancia del índice tobillo-brazo como técnica de criba. Rev Esp Cardiol. 2009;9(4):11-1.
32) Suárez C, Lozano FS (coord.), Bellmunt S, Camafort M, Díaz S, Mancera J, et al. Documento de consenso multidisciplinar entorno a la enfermedad arterial periférica. 1ª ed. Madrid: Luzán 5, 2012.
33) Tranche-Iparraguirre S, Marín-Iranzo R, Fernández-de Sanmamed R, Riesgo-García A, Hevia-Rodríguez E, García-Casas JB. Peripheral arterial disease and kidney failure: a frequent association. Nefrologia. 2012;32(3):313-20. doi: 10.3265/Nefrologia.pre2011.
34) Forés R, Alzamora MT, Pera G, Torán P, Urrea M, Heras A. Concordancia entre 3 métodos de medición del índice tobillo-brazo para el diagnóstico de arteriopatía periférica. Med Clin (Barc). 2014;143(8):335-40. doi: 10.1016/j.medcli.2013.10.029.
35) Nogales JM. Diagnóstico precoz de la arteriopatía periférica mediante la determinación automática del índice tobillo-brazo. Med Clin (Barc). 2014;143(8):352-53. doi: 10.1016/j.medcli.2014.01.013.
36) Serrano Hernado FJ, Conejero AM. Enfermedad arterial periférica: aspectos fisiopatológicos, clínicos y terapéuticos. Rev Esp Cardiol. 2007;60(9):969-82. doi: 10.1157/13109651.
37) Kasiske BL, Chakkera HA, Roel J. Explained and unexplained ischemic heart disease risk after renal transplantation. J Am Soc Nephrol. 2000;11(9):1735-43.
38) Covic A, Gusbeth-Tatomir P, Goldsmith DJ. The challenge of cardiovascular risk factors in end-stage renal disease. J Nephrol. 2003;16(4):476-86.
39) Kiberd B, Panek R. Cardiovascular outcomes in the outpatient kidney transplant clinic: the Framingham risk score revisited. Clin J Am Soc Nephrol. 2008; 3(3):822-8. doi: 10.2215/CJN.00030108.
2) Vallejo OG. Utilidad del índice tobillo-brazo para el diagnóstico de la enfermedad arterial periférica. Clin Invest Arterioscl. 2011;23(1):29-30. doi: 10.1016/j.arteri.2011.03.006.
3) Maggi DL, Dal Piva de Quadros LR, de Oliveira Azzolin K, Goldmeier S. Índice tornozelo-braquial: estratégia de enfermeiras na identificação dos fatores de risco para doença cardiovascular. Rev Esc Enferm USP. 2014;48(2):223-7. doi: 10.1590/s0080-623420140000200004.
4) Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725-30. doi: 10.1056/NEJM199912023412303.
5) Mostaza JM, Manzano L, Suárez C, Cairols M, Ferreira EM, Rovira E, et al. Prevalencia de enfermedad arterial periférica asintomática, estimada mediante el índice tobillo-brazo, en pacientes con enfermedad vascular. Estudio MERITO II. Med Clin (Barc). 2008;131(15):561-5. doi: 10.1157/13128016.
6) Félix-Redondo FJ, Fernández-Bergés D, Grau M, Baena-Diez JM, Mostaza JM, Vila J. Prevalence and clinical characteristics of peripheral arterial disease in the study population Hermex. Rev Esp Cardiol (Engl Ed). 2012;65(8):726-33. doi: 10.1016/j.recesp.2012.03.008.
7) Blanes JI, Cairols MA, Marrugat J; ESTIME. Prevalence of peripheral artery disease and its associated risk factors in Spain: The ESTIME Study. Int Angiol. 2009;28(1):20-5.
8) Bendermacher BL, Teijink JA, Willigendael EM, Bartelink ML, Büller HR, Peters RJ, et al. Symptomatic peripheral arterial disease: the value of a validated questionnaire and a clinical decision rule. Br J Gen Pract. 2006;56(533):932-7.
9) Pita-Fernández S, Modroño-Freire MJ, Pértega-Díaz S, Herrera-Díaz L, Seoane-Pillado T, Paz-Solís A, et al. Validity of the Edinburgh claudication questionnaire for diagnosis of peripheral artery disease in patients with type 2 diabetes. Endocrinol Diabetes Nutr. 2017;64(9):471-9. doi: 10.1016/j.endien.2017.06.003.
10) Leskinen Y, Salenius JP, Lehtimäki T, Huhtala H, Saha H. The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics. Am J Kidney Dis. 2002;40(3):472-9. doi: 10.1053/ajkd.2002.34885.
11) Basgoz BB, Tasci I, Yildiz B, Acikel C, Kabul HK, Saglam K. Evaluation of self-administered versus interviewer-administered completion of Edinburgh Claudication Questionnaire. Int Angiol. 2017;36(1):75-81. doi: 10.23736/S0392-9590.16.03645-2.
12) Sociedad Española de Nefrología. Registro Español de Enfermos Renales. Informe de Diálisis y Trasplante 2011 [Internet]. Disponible en: https://www.senefro.org/modules/webstructure/files/reercongsen2012.pdf.
13) Garimella PS, Hart PD, O'Hare A, DeLoach S, Herzog CA, Hirsch AT. Peripheral artery disease and CKD: a focus on peripheral artery disease as a critical component of CKD care. Am J Kidney Dis. 2012;60(4):641-54. doi: 10.1053/j.ajkd.2012.02.340.
14) Wattanakit K, Folsom AR, Selvin E, Coresh J, Hirsch AT, Weatherley BD. Kidney function and risk of peripheral arterial disease: results from the Atherosclerosis Risk in Communities (ARIC) Study. J Am Soc Nephrol. 2007;18(2):629-36. doi: 10.1681/ASN.2005111204.
15) Lash JP, Go AS, Appel LJ, He J, Ojo A, Rahman M, et al.; Chronic Renal Insufficiency Cohort (CRIC) Study Group. Chronic Renal Insufficiency Cohort (CRIC) Study: baseline characteristics and associations with kidney function. Clin J Am Soc Nephrol. 2009;4(8):1302-11. doi: 10.2215/CJN.00070109.
16) United States Renal Data System. USRDS 2007Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Am J Kidney Dis. 2008;51(1 Suppl. 1): S1-S320.
17) Snyder JJ, Kasiske BL, Maclean R. Peripheral arterial disease and renal transplantation. J Am Soc Nephrol. 2006;17(7):2056-68. doi: 10.1681/ASN.2006030201.
18) Wu SW, Lin CK, Hung TW, Tsai HC, Chang HR, Lian JD. Subclinical peripheral arterial disease in renal transplantation. Am J Med Sci. 2014;347(4):267-70. doi: 10.1097/MAJ.0b013e3182896a33.
19) Young MJ, Adams JE, Anderson GF, Boulton AJ, Cavanagh PR. Medial arterial calcification in the feet of diabetic patients and matched non-diabetic control subjects. Diabetologia. 1993;36(7):615-21. doi: 10.1007/BF00404070.
20) Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L, et al.; American College of Cardiology Foundation Task Force; American Heart Association Task Force. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(14):1555-70. doi: 10.1016/j.jacc.2013.01.004.
21) Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl. S):S5-67. doi: 10.1016/j.jvs.2006.12.037.
22) Franke GH, Reimer J, Kohnle M, Luetkes P, Maehner N, Heemann U. Quality of life in end-stage renal disease patients after successful kidney transplantation: development of the ESRD symptom checklist - transplantation module. Nephron. 1999;83(1):31-9. doi: 10.1159/000045470.
23) Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol. 1998;9(12 Suppl.):S16-23.
24) Moreno-Carriles RM. Registro de actividad de la Sociedad Española de Angiología y Cirugía Vascular, año 2007. Angiología. 2008;60(4):291-316.
25) Forés R, Alzamora MT, Baena JM, Pera G, Torán P, Ingla J, et al. Infradiagnóstico de la arteriopatía periférica en la población española. Estudio ARTPER. Med Clin (Barc). 2010;135(7):306-9. doi: 10.1016/j.medcli.2009.11.046.
26) Alonso I, Valdivielso P, Zamudio MJ, Sánchez M.A, Pérez F, Ramos H, et al. Rentabilidad del índice tobillo-brazo para la detección de enfermedad arterial periférica en población laboral de la Junta de Andalucía en Málaga. Med Clin (Barc). 2009;132(1):7-11. doi: 10.1016/j.medcli.2008.02.002.
27) Vicente I, Lahoz C, Taboada M, García A, San Martín MA, Terol I, et al. Prevalencia de un índice tobillo-brazo patológico según el riesgo cardiovascular calculado mediante la función de Framingham. Med Clin (Barc). 2005;124(17):641-4. doi: 10.1157/13074738.
28) Ramos R, Quesada M, Solanas P, Subirana I, Sala J, Vila J, et al.; REGICOR Investigators. Prevalence of symptomatic and asymptomatic peripheral arterial disease and the value of the ankle-brachial index to stratify cardiovascular risk. Eur J Vasc Endovasc Surg. 2009;38(3):305-11. doi: 10.1016/j.ejvs.2009.04.013.
29) Carbayo JA, Divisón JA, Escribano J, López-Abril J, López de Coca E, Artigao LM, et al.; Grupo de Enfermedades Vasculares de Albacete (GEVA). Using ankle-brachial index to detect peripheral arterial disease: prevalence and associated risk factors in a random population sample. Nutr Metab Cardiovasc Dis. 2007;17(1):41-9. doi: 10.1016/j.numecd.2005.08.009.
30) Puras Mallagray E. Claudicación: epidemiología e historia natural. Angiología. 2010;62(Esp Cong):52-6.
31) Guindo J, Martínez-Ruíz MD, Gusi G, Punti J, Bermúdez P, Martínez-Rubio A. Métodos diagnósticos de la enfermedad arterial periférica. Importancia del índice tobillo-brazo como técnica de criba. Rev Esp Cardiol. 2009;9(4):11-1.
32) Suárez C, Lozano FS (coord.), Bellmunt S, Camafort M, Díaz S, Mancera J, et al. Documento de consenso multidisciplinar entorno a la enfermedad arterial periférica. 1ª ed. Madrid: Luzán 5, 2012.
33) Tranche-Iparraguirre S, Marín-Iranzo R, Fernández-de Sanmamed R, Riesgo-García A, Hevia-Rodríguez E, García-Casas JB. Peripheral arterial disease and kidney failure: a frequent association. Nefrologia. 2012;32(3):313-20. doi: 10.3265/Nefrologia.pre2011.
34) Forés R, Alzamora MT, Pera G, Torán P, Urrea M, Heras A. Concordancia entre 3 métodos de medición del índice tobillo-brazo para el diagnóstico de arteriopatía periférica. Med Clin (Barc). 2014;143(8):335-40. doi: 10.1016/j.medcli.2013.10.029.
35) Nogales JM. Diagnóstico precoz de la arteriopatía periférica mediante la determinación automática del índice tobillo-brazo. Med Clin (Barc). 2014;143(8):352-53. doi: 10.1016/j.medcli.2014.01.013.
36) Serrano Hernado FJ, Conejero AM. Enfermedad arterial periférica: aspectos fisiopatológicos, clínicos y terapéuticos. Rev Esp Cardiol. 2007;60(9):969-82. doi: 10.1157/13109651.
37) Kasiske BL, Chakkera HA, Roel J. Explained and unexplained ischemic heart disease risk after renal transplantation. J Am Soc Nephrol. 2000;11(9):1735-43.
38) Covic A, Gusbeth-Tatomir P, Goldsmith DJ. The challenge of cardiovascular risk factors in end-stage renal disease. J Nephrol. 2003;16(4):476-86.
39) Kiberd B, Panek R. Cardiovascular outcomes in the outpatient kidney transplant clinic: the Framingham risk score revisited. Clin J Am Soc Nephrol. 2008; 3(3):822-8. doi: 10.2215/CJN.00030108.
Published
2021-06-22
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1.
Lema-Verdía L, Balboa-Barreiroa V, Couceiro-Sánchez E, González-Martín C, Pértega-Díaz S, Seoane-Pillado T, Pita-Fernández S. Peripheral arterial disease in renal transplant patients. Validity of the Edinburgh questionnaire for disease diagnosis. Rev Nefrol Dial Traspl. [Internet]. 2021Jun.22 [cited 2024Jul.16];41(2):100-12. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/646
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