Peripheral Artery Disease

Scott E. Janus, MD, on Predicting PAD Risk in Patients With CKD

New research1 sheds light on a novel biomarker that may accurately predict new-onset peripheral arterial disease (PAD) in patients with chronic kidney disease (CKD).

The study team—which consisted of Sadeer G. Al-Kindi, MD; Scott E. Janus, MD; and Jamal Hajjari, MD—evaluated the association between the high-sensitivity troponin (HsTP) assay and the risk of PAD in patients with CKD.

To learn more about the study and its findings, Consultant360 reached out to corresponding author Dr Janus, who is a second-year fellow in the Division of Cardiovascular Medicine at University Hospitals Cleveland Medical Center in Cleveland, Ohio.

CON360: Can you tell us more about your study and what you found?

Scott Janus: In brief, we studied the well-validated Chronic Renal Insufficiency Cohort database. This was a prospective cohort of 3939 individuals with mild to moderate CKD. HsTP levels, among other biomarkers, were obtained at the study enrollment. Patients were followed for development of incident PAD. We used COX regression analysis, and after adjusting for multiple clinical risk factors, we found that patients in the third and fourth quartiles of HSTP had significantly higher risk of incident PAD compared with lowest quartile of HsTP.

CON360: Overall, you and your team found that the HsTP assay accurately predicted PAD among patients with mild to moderate CKD. What does this finding mean for clinical practice and how PAD might be managed in this population in the future?

SJ: This is an interesting and exciting finding. Even though HsTP was originally intended to discern myocardial ischemia, it may be able to help predict other future cardiovascular end points (such as PAD, atrial fibrillation, etc). Using biomarkers to reliably and accurately predict future incident PAD in patients with CKD may help reduce the morbidity and mortality in this high-risk population.

CON360: What knowledge gaps still exist regarding managing PAD among patients with CKD?

SJ: Despite the known association between PAD and CKD, the exact pathophysiologic mechanisms remain unknown. This is why investigating novel biomarkers like HsTP is important to help early identification of patients at risk and initiate early treatment.

CON360: What is the key take-home message for cardiologists?

SJ: HsTP levels are strongly associated with risk of incident PAD in patients with mild to moderate CKD. The association remained statistically significant despite accounting for traditional PAD risk factors.

Reference:

  1. Janus SE, Hajjari J, Al-Kindi SG. High sensitivity troponin and risk of incident peripheral arterial disease in chronic kidney disease (from the Chronic Renal Insufficiency Cohort [CRIC] Study). Am J Cardiol. 2020;125(4):630-635. https://doi.org/10.1016/j.amjcard.2019.1019.