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SM Journal of Nephrology and Kidney Diseases

Does Hemodialysis Patients Have A Better Quality of Life Than Peritoneal Dialysis Patients?

[ ISSN : 2576-5450 ]

Abstract Keywords Citation Introduction Data and Methods Results Discussion Conclusion References
Details

Received: 28-Aug-2024

Accepted: 30-Sep-2024

Published: 30-Sep-2024

Mini Review | Volume 5 - Issue 1 | Article DOI :

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Zhao Ruobing¹*, Zhang Wei², Sun Mengdi¹ and Yang Chao¹

¹School of Medicine of Jiangsu University, China
²Jingjiang College of Jiangsu University, China

Corresponding Author:

Zhao Ruobing, Jiangsu of University, China

Abstract

Objective : To systematically evaluate the effect of peritoneal dialysis and hemodialysis on patients’ quality of life.

Methods : Computer searched the quality of life of patients comparing peritoneal dialysis and hemodialysis in CNKI, Wanfang database, VIP database, the Cochrane Library, PubMed and Web of Science database, searching the database until November 30,2023. Statistical analysis and mapping were performed using the Review Manager 5.3 software.

Results : A total of 26 articles were included for a total of 25501 study subjects. The results of the Meta-analysis showed that, Compared with the hemodialysis patients, The Peritoneal dialysis patients had better quality of life (MD= -9.36, 95%CI =-13.45~-5.26, P<0.001), In the physiological function (MD=2.34, 95%CI =0.134.56, P <0.05), physical pain (MD=3.82, 95%CI=0.836.81, P <0.05), general health (MD=1.57, 95%CI=1.052.08, P <0.05), psychological status (MD=1.94, 95%CI=0.033.85, P <0.05) and the domain differences were significant.

Conclusion: Peritoneal dialysis patients have better quality of life than hemodialysis patients

Keywords

  • Peritoneal dialysis
  • Hemodialysis
  • Dialysis
  • Quality of life
  • Meta integration

Citation

Ruobing Z, Wei Z, Mengdi S, Chao Y (2024) Does Hemodialysis Patients Have A Better Quality of Life Than Peritoneal Dialysis Patients?. J Nephrol Kidney Dis 5: 7.

Introduction

In recent years, with the rapid development of social, medical and economic development around the world, the number of patients with end-stage renal disease (ESRD) is increasing year by year [1]. Renal replacement therapy (RRT) is an important life-sustaining treatment for patients with chronic end-stage renal disease (ESRD), among which peritoneal dialysis and haemodialysis are the main methods of RRT. The focus of research in the medical field has gradually shifted from “clinical outcomes” to “patient-centred outcomes”. Health-related quality of life (HRQoL) has become an important indicator for evaluating different modalities of renal replacement therapy (RRT) [2]. Health-related quality of life (HRQoL) is defined by the World Health Organisation as an individual’s subjective feelings and perceptions about their physical health, mental health, social functioning and environmental adaptability [3]. The results of studies on which alternative treatment modalities provide patients with a better quality of life are controversial [4]. Therefore, in this study, we objectively compared and assessed the effects of peritoneal dialysis (PD) and haemodialysis (HD) on patients’ quality of life by meta-analysis, and thoroughly investigated the advantages and disadvantages of dialysis modalities in terms of patients’ quality of life,
with the aim of providing patients and clinicians with more informed decision support.

Data and Methods

Inclusion and exclusion criteria
Inclusion criteria: 1) the type of study is case-control or cohort study; 2) domestic and foreign published literature on the quality of life of peritoneal dialysis and haemodialysis patients in both Chinese and English; 3) the outcome indicators are the scores of different dimensions, and the assessment tool is the Brief Health Status Questionnaire.
Exclusion criteria: (1) incomplete data; (2) duplicate publications, conference papers; (3) full text could not be obtained through various means.

Search strategy

We searched China Knowledge Network (CNN), Wanfang, Wipro, China Biomedical Literature Database (CBLD), PubMed, Embase, Cochrane, Web of Science, Scopus databases or platforms, and the search period was from the establishment of the databases to 30 November 2023, and we used a combination of subject terms and free words to search the databases. Searches were conducted using a combination of subject headings and free words.

Data extraction and quality assessment

Two reviewers independently extracted data and assessed the quality of the literature, and in case of disagreement, a third reviewer was asked for further discussion and decision, if necessary. The Methodological Index for Non-Randomised Studies (MINORS) [5] was used to assess the quality of the included literature, which included whether the purpose of
the study was clear, the consistency of the patients included, whether the expected data were collected, whether the outcome measures adequately reflected the purpose of the study, the objectivity of the assessment of the outcome measures, and the quality of the study results. The assessment included whether the purpose of the study was clear, whether the expected data were collected, whether the endpoint measures appropriately reflected the purpose of the study, whether the endpoint measures were objectively assessed, whether follow-up was adequate, whether the dropout rate was less than 5%, and whether the sample size was estimated; Each item was scored from 0 to 2, with 0 indicating no reporting, 1 indicating reporting but inadequate, and 2 indicating reporting and adequate, and an ideal score of 24 points was obtained, and a total score of 0-8 points was classified as low quality, 9-16 points as moderate quality, and 17-24 points as high quality.

Statistical methods

Meta-analyses of the relevant data were performed using RevMan 5.3 and R language software. Measurement data were expressed as mean difference (MD), and effect sizes were expressed as 95% confidence intervals (CI); the χ2 test was used to determine heterogeneity, and if P>0.05 and I 2 <50%, there was no statistically significant heterogeneity between studies and a fixed-effects model was used for meta-analysis; conversely, a random-effects model was chosen for meta-analysis.

Results

Results of the literature search
The preliminary search of the database yielded 1113 articles of relevant literature, and 26 articles were finally included according to the inclusion and exclusion criteria, with a total of 25,501 patients. The literature screening process and results are shown in Figure 1.

Main characteristics and quality assessment of the included studies
Of the 1113 studies published between 1997 and 2016, a total of 26 studies were eligible, as shown in Figure 1. The characteristics of the included studies are shown in Table 1.These studies included approximately 25,501 participants, and the study sample sizes ranged from 51 to 18,015 participants. Twenty-four of the 26 studies were crosssectional.
Twenty-six of the 26 studies assessed patients’ quality of life SF- 36 scale Twenty-six of the 26 studies were cross-sectional, and 26 studies assessed patients’ quality of life SF-36 scale scores on each dimension. Details of the included literature are shown in Table 1. 

Table 1: includes the basic characteristics of the included studies (n = 26).

      Sample Size   Male/Female (%) Outcome  
Author (Publication Year) Country Research Type Average Age Indicator MINORS Score
    Cross-sectional studies          
Enjalbert 2019[6] Switzerland 216 N/A 66.2 ① High quality
    Cross-sectional studies          
Cristina 2014[7] Brazil 317 N/A 57.4 ① Medium quality
    Cross-sectional studies          
Czyzewski 2014[8] Poland 70 N/A N/A ① High quality
    Cross-sectional studies          
diaz-buxo 2000[9] United States 18015 58.66 51.61 ① Medium quality
               
Jung 2019[10] South Korea Forward looking 989 54.89 38.32 ① High quality
    Cross-sectional studies          
Kalender 2007[11] Turkey 115 49.83 57.5 ① High quality
    Cross-sectional studies          
Kang 2017[12] South Korea 1616 55.87 55.88 ① High quality
    Cross-sectional studies          
Kontodimopoulos 2009[13] Greece 707 55.39 59.84 ① Medium quality
    Cross-sectional studies          
Kostro 2016[14] Poland 69 46.46 36.23 ① High quality
    Cross-sectional studies          
Lee 2005[15] United Kingdom 173 57.09 58.59 ① Medium quality
    Cross-sectional studies          
Mathew 2023[16] South Africa 100 N/A 48 ① Medium quality
    Cross-sectional studies          
Merkus 1997[17] Netherlands 226 56.02 60.75 ① High quality
Merkus 1999[18] Netherlands Forward looking 139 56.83 60.54 ① High quality
    Cross-sectional studies          
Sayin 2007[19] Turkey 116 N/A 68.1 ① High quality
    Cross-sectional studies          
Turkmen 2011[20] Turkey 154 53.92 55.84 ① Medium quality
  United Kingdom of Great Britain and Northern Ireland Cross-sectional studies          
Wight 1998[21] 209 N/A 59.27 ① Medium quality
    Cross-sectional studies          
Zhanghua 2007[22] China 1062 58.89 49.44 ① High quality
    Cross-sectional studies          
Lei Hongying 2011 [23] China 160 48.6 26.25 ① Medium quality
    Cross-sectional studies          
Li Li 2015[24] China 98 N/A 47.96 ① Medium quality
    Cross-sectional studies          
Matsu 2004 [25] China 302 N/A N/A ① Medium quality
    Cross-sectional studies          
Genna Guli 2012 [26] China 175 75.37 63.43 ① Medium quality
    Cross-sectional studies          
Shi Xiaoyan 2016 [27] China 130 51.21 29.23 ① Medium quality
    Cross-sectional studies          
Wu Xing 2003 [28] China 96 49.43 54.17 ① Medium quality
    Cross-sectional studies          
Xu Jun 2018 [29] China 100 51 50 ① Medium quality
    Cross-sectional studies          
Yip Pui Yee 2016 [30] China 256 N/A N/A ① Medium quality
    Cross-sectional studies          
Zheng Junyong 2017 [31] China 51 46.29 49.02 ① Medium quality
 
Note: N/A: indicates that information is not available; ① patients' SF-36 scale scores for each dimension;

Meta-analysis results
Twenty-six studies [6-31] reported scores on eight domains of the SF-36 scale between PD and HD, and the data were subjected to metaanalysis to calculate effect sizes for each dimension. The heterogeneity of I2 between different studies ranged from 82.0 to 92.0%, so a random effects model was used for all studies. The results showed that the effect scores of all domains were generally biased in favour of PD, but only for physiological functioning (MD = 2.34, 95% CI = 0.13-4.56, P < 0.05), bodily pain (MD = 3.82, 95% CI = 0.83-6.81, P < 0.05), general pain (MD = 3.82, 95% CI = 0.83-6.81, P < 0.05), general health (MD = 3.82, 95% CI = 0.83-6.81, P < 0.05), and general health (MD = 3.82, 95% CI = 0.83- 6.81, P < 0.05), general health (MD=1.57,95%CI=1.05~2.08,P<0.05) and mental health (MD=1.94, 95%CI=0.03~3.85, P<0.05) dimensions were significant, see Table 2.

Table 2: Summary of the results of Meta-analysis of SF-36 dimensions

Outcome Indicators Included studies (n) Number of patient cases Statistical heterogeneity Effect model Meta-analysis results
Physiological functions 26 25501 P<0.001,I2=85% Random MD=2.34, 95%=0.13~4.56, P=0.04
Physiological functions 26 25501 P<0.001,I2=90% Random MD=1.86, 95%=-1.89~5.62, P=0.33
Somatic pain 26 25501 P<0.001,I2=92% Random MD=3.82, 95%=0.83~6.81, P=0.01
           
General health 26 25501 P<0.001,I2=83% Random MD=1.57, 95%=1.05~2.08, P<0.001
Energy 26 25501 P<0.001,I2=82% Random MD=0.79, 95%=-0.93~2.52, P=0.37
Social function 26 25501 P<0.001,I2=86% Random. MD=2.15, 95%=-0.26~4.57, P=0.08
Emotional function 26 25501 P<0.001,I2=86% Random. MD=3.46, 95%=-0.12~7.04, P=0.06
Mental Health 26 25501 P<0.001,I2=87% Random. MD=1.94, 95%=0.03~3.85, P=0.04

Publication bias
In this study, a funnel plot was drawn for the physiological functions of patients. The results showed that the funnel plot was basically symmetrical, indicating that the possibility of publication bias in the included literature was small, see Figure 2.

Figure 2: Physiological function funnel diagram

Discussion

This study pooled the SF-36 scores of 26 studies [6-37] to compare the effects of different dialysis treatment modalities on patients’ quality of life. Most of the previously published studies conducted systematic reviews to clarify the current situation and summarise the effects of different dialysis treatment modalities on patients’ quality of life, and few studies conducted meta-analyses to investigate the differences in patients’ quality of life between abdominal dialysis and haemodialysis. In this study, based on a large amount of research data and direct and indirect comparative evidence, we obtained a comparative evaluation of the effects of different dialysis treatment modalities on patients’ quality of life, and the results of the meta-analysis showed that patients with abdominal dialysis were better than patients with haemodialysis in the areas of physiological function, bodily pain, general health and psychological status in the aspect of quality of life, thus providing a
certain reference value for the decision-making of patients on dialysis in the clinical setting.

Results of the meta-analysis

Some of the aspects in which patients with peritoneal dialysis are superior to those with haemodialysis may be due to the flexibility and autonomy of peritoneal dialysis treatment, which allows the patient to complete the treatment at home and reduces the need for frequent trips to the hospital, which may give the patient more autonomy and comfort [38]. Haemodialysis requires frequent intubation and blood circulation, which can sometimes cause discomfort and pain associated with venous access [39], whereas peritoneal dialysis may cause less physical pain to patients. Therefore, compared with haemodialysis, peritoneal dialysis may result in less physical pain and discomfort and to some extent improve the patient’s quality of life, including general health and work status [25]. This type of home treatment also has the potential to reduce the psychological burden on the patient and may have a positive impact on the patient’s mental health by reducing the psychological stress associated with frequent hospital visits compared with in-centre haemodialysis [40]. As peritoneal dialysis is a 24-hour continuous dialysis, the body is closer to the physiological state and maintains the stability of the internal environment; the haemodynamic effects are small, the incidence of cardiovascular, cerebral and haemorrhagic complications is low, there is no restriction of activities and the quality of life is higher, which is more suitable for patients with terminal illnesses [41]. However, different patient conditions and treatment settings may lead to different
treatment choices, so optimal treatment needs to be discussed between health professionals and patients and personalised according to individual circumstances.

Limitations of the study

It should be noted that the study is subject to a number of limitations. Firstly, despite the implementation of a comprehensive search strategy for this study, there is a possibility of omission due to the inherent limitations of any such strategy. Secondly, the majority of the data were derived from cross-sectional designs of observational studies, which may
be susceptible to selection and confounding bias and tend to diminish the strength of the evidence in this study. In conclusion, the aforementioned factors should be taken into account when applying the evidence from this study in practice, and it should be selected with great care. The present study can only draw an exploratory conclusion, and further highquality, directly comparable RCTs are required in the future to validate and complement the existing evidence.

Conclusion

This study showed that patients on peritoneal dialysis had a moderately better quality of life than patients on haemodialysis, as assessed by the SF-36 self-report instrument. Therefore, the results of this study can be used as a reference for the choice of dialysis modality, focusing on peritoneal dialysis according to the actual situation of the patients. However, in future studies, rigorous multicentre RCTs with large sample sizes should be designed to confirm the present findings and to examine the trends over time between PD and haemodialysis patients, as well as the relationship with clinical outcomes such as hospitalisation and mortality, in order to provide some reference for clinicians and patients in choosing the appropriate dialysis technique.

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Serum Glycoprotein Chondrex (YKL-40) and High Sensitivity C- Reactive Protein (hscrp) in Type 2 Diabetic Patients in Relation to Cardiovascular Complications

In Type 2 diabetes, C-Reactive Protein (CRP) as an inflammatory marker may be elevated. The glycoprotein Chondrex or YKL-40 is over expressed in many inflammatory conditions. The aim is to study serum hsCRP and YKL-40 in Type 2 diabetic patients in relation to cardiovascular complications.

Methods: Eighty subjects were divided into 3 groups: GROUP 1:16 apparently healthy controls, GROUP 2:16 patients suffering from Type 2 DM without cardiovascular complications and GROUP 3: 48 patients suffering from Type 2 DM with cardiovascular complications. Subjects with acute or chronic inflammation, autoimmune disease or malignancy were excluded. Electrocardiography, Carotid Intima Thikness, Fundus Examination, laboratory investigations: (Complete urine analysis, urinary albumin, Creatinine and calculation of urinary albumin to creatinine ratio, fasting and postprandial glucose, glycated hemoglobin, Creatinine and uric acid, lipid profile, glomerular filtration rate, CRP and YKL-40) were done to all subjects.

Results: High sensitivity CRP levels were significantly elevated in the diabetic group with cardiovascular complications when compared to the diabetic group without cardiovascular complications (p=0.024). YKL-40 was significantly higher in patients with type 2 diabetes mellitus than controls (p=0.017) and cardiovascular complications (p<0.001) contributed to its greater elevation.YKL-40 was positively correlated with triglycerides, systolic and mean blood pressure in the group of diabetic patients without cardiovascular complications and with duration of diabetes and urinary albumin to creatinine ratio in the group with cardiovascular complications. By drawing receiver operating characteristic (ROC) curve between diabetic patients without and with cardiovascular complications the AUC for hsCRP was (0.676, p=0.036) and for YKL-40 was (0.743, p=0.004). By studying the diagnostic performance, YKL-40 had a better specificity and positive predictive value than hsCRP.

Conclusion: YKL-40 has a better specificity and positive predictive value than hsCRP in discriminating between diabetic patients with cardiovascular complications from those without cardiovascular complications.

El-Attar HA¹*, El-Deeb MM¹ and El-Ghlied LA²

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Is There An Association Between Angiotensin II Type 1 Receptor A1166C Gene Polymorphism and Renal Scarring Susceptibility?

Relationship between Angiotensin II Type 1 Receptor (AT1R) A1166C gene polymorphism and renal scarring risk is still controversial. This meta-analysis was performed to evaluate the association of AT1R A1166C gene polymorphism and renal scarring risk susceptibility. A predefined literature search and selection of eligible relevant studies were performed to collect data from electronic databases of PubMed, Embase and Cochrane Library. Three literatures were identified and included for the analysis of the relationship between AT1R A1166C gene polymorphism and renal scarring risk. We found that AT1R A1166C gene polymorphism was not associated with renal scarring susceptibility using the comparison of patients with scarring vs patients without scarring (C: OR=1.33, 95%CI: 0.83-2.13, P=0.23; CC: OR=1.71, 95%CI: 0.22-13.56, P=0.61; AA: OR=0.69, 95%CI: 0.39-1.21, P=0.20). Furthermore, AT1R A1166C gene polymorphism was also not associated with renal scarring risk using the comparison of patients with scarring vs healthy control. In conclusion, AT1R A1166C gene polymorphism was not associated with renal scarring risk susceptibility. However, more studies should be performed in the future.

Tianbiao Zhou*#, Weiji Xie#, Zhijun Lin# and Zhensheng Yang

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Evaluation of Antidiabetic Plants used by Tribes of Telangana State on Diabetic Complications like Neuropathy, Nephropathy and Cardiomyopathy in Rats

Background: India is “diabetes capital of the world”. Diabetes Atlas 2006 published by International Diabetes Federation, India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken. Over the past 30 yr, the status of diabetes has changed from being considered as a mild disorder to major causes of morbidity and mortality.

Methods: Rats treated with Alloxan (150 mg/kg) i.p. results diabetic rats given ethanol extract of Senna auriculata leaf, Syzygium cumini (L.) Skeels seeds and Syzygium cumini (L.) Skeels seeds (150 mg/kg) p.o., respectively for 42 days. Biochemical parameters of diabetic neuropathy, nephropathy and cardiomyopathy and histopathology of sciatic nerve, kidney and heart was done at the end of study.

Results: In Diabetic Group found Blood Glucose Level (BGL) (84.42±6.384 to 369.36±7.784mg/dl); Muscle Grip Strength (MGS) (59.32±1.052 to 13.52±0.883seconds); Thermal Pain Response (TPR) (5.55±0.621 to 13.67±1.164seconds). blood protein (7.48±0.051 to 25.18±0.046mg/dl); urine protein (0.692±0.061 to 2.68±0.056mg/dl); blood albumin (1.94±0.043 to 0.248±0.007mg/dl); urine albumin (0.082±0.009 to 2.68±0.056mg/dl); blood myoglobin (0.042±0.00274 to 0.056±0.00207ng/dl); urine myoglobin (0.0048±0.00142 to 0.0098±0.00107mg/dl); Blood Urea Nitrogen (BUN) (23.04±1.093 to 124.81±1.238 mg/dl); Serum Creatinine (84.06±6.723 to 218.56±7.586 (µMol/dl). Etholic extract of Senna auriculata leaf, Phyllanthus emblica.L. fruits and Syzygium cumini (L.) Skeels seeds & combination treated groups found BGL124.42±7.042, 112.07±6.942, 126.25±7.051 & 98.83±6.932mg/dl; MGS 49.06±0.962, 52.05±1.247, 54.06±1.268 & 56.79±1.125 seconds; TPR 6.54±0.841, 7.38±0.802, 6.45±1.062 & 6.14±0.837 seconds; blood protein 7.98±0.039, 8.02±0.053, 8.06±0.039 & 7.48±0.045mg/dl; urine protein 1.22±0.058, 0.94±0.049, 0.96±0.056 & 0.82±0.062mg/dl; blood albumin 1.64±0.033, 1.82±0.036, 1.87±0.044 & 1.96±0.039mg/dl; urine albumin 0.122±0.008, 0.098±0.007, 0.132±0.009 & 0.108±0.011mg/dl; blood myoglobin 0.045±0.00189, 0.036±0.00177, 0.041±0.00223 & 0.043±0.00175ng/dl; urine myoglobin 0.0042±0.00129, 0.0052±0.00119, 0.0064±0.00126 & 0.0036±0.00125mg/dl; BUN 35.81±1.186, 36.06±1.123, 34.53±1.177 & 29.03±1.229mg/dl; Serum Creatinine 98.42±5.526, 99.73±6.064, 101.97±6.052 & 94.83±6.678µMol/dl.

Conclusion: Ethanol extract of Senna auriculata leaf, Phyllanthus emblica L. fruit and Syzygium cumini (L.) Skeels seeds (150mg/kg) and its combination normalizes biochemical parameters & Morphological changes in sciatic nerve, myocardium & kidney and improvement of the general behavioral parameters. Combination was found to be more effective in these diabetic complications.

Syed Ahmed Hussain and Ashish Kumar Sharma*

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Uric Acid, Metabolic Risk Factors, and Chronic Kidney Disease: Clinical Investigation in a Female Elderly Occupational Population in Taipei, Taiwan

Purpose: To explore the prevalence and associated factors for Chronic Kidney Disease (CKD) among female elderly fishing and agricultural population in Taipei, Taiwan.

Methods: Females (n=1,606) aged 65 years and over voluntarily admitted to a teaching hospital for a physical check-up were collected in 2010.

Results: The prevalence of CKD was 8.2%. Age, hyperuricemia, and hyperglycemia were statistical significantly related to CKD. The sensitivity and specificity of serum uric acid and fasting blood glucose concentration as a marker of CKD were estimated 76.5%, 70.9% and 51.5%, 53.5%, respectively.

Conclusion: Hyperuricemia and hyperglycemia independently affect the prevalent CKD in this sub-population.

Ya-Ting Liang¹, Hsi-Che Shen²˒³˒⁴, Yi-Chun Hu²˒³˒⁵, Yu-Fen Chen⁶˒⁷˒⁸ and Tao-Hsin Tung⁹˒¹⁰˒¹¹*

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Pseudohypercreatininemia after Sustanon Injection

The drugs used in the treatment of certain diseases may give impression of impaired renal function. These drugs cause a false high serum creatinine level. Laboratory findings other than serum creatinine and hypertriglyceridemia were normal. We presented a 28-year-old male with a high serum creatinine level, who was referred for consideration of urgent renal replacement therapy. The results of the investigations revealed that the result was the falsely-elevated serum creatinine due to the sustenance injection.

Can Hüzmeli¹, Mustafa Sağlam¹, Bariş Döner¹, Serkan Çağlar² and Özkan Güngör³

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Peripheral Arterial Disease Holding Central Stage in Chronic Kidney Disease (Kdoqi Stage 3-5): Prevalence and Related Risk Factors - Experience from Kashmir Valley Tertiary Care Centre

Patients with CKD are highly predisposed for developing accelerated atherosclerosis. These patients have non-traditional risk factors such inflammation, malnutrition and increased oxidative stress that enhance and accelerate atherosclerosis in addition to traditional risk factors. Although relation between cardiovascular and cerebrovascular diseases with CKD is well established, studies are suggesting about association of Peripheral Arterial Disease (PAD) with CKD. PAD is associated with increased morbidity and mortality in patients of CKD.

This study is rendezvous to look for PAD and related risk factors in patients of CKD having eGFR less than 60 ml/ min/ 1.73 m2 (MDRDS) and not on RRT.

Two hundred ten subjects with CKD attending department of nephrology at tertiary care institute in valley were included in study. Out of 210 subjects selected, 30 were having PAD that constituted 14% of study population. IC was seen in 25 (11.9%) of 210 subjects. Out of PAD patients 16 (53.3%) were having history of IC and 14 (46.7%) were asymptomatic. As reported in literature, prevalence of peripheral arterial disease in CKD patients not on dialysis ranged from 7% to 32% in previous cases. This study will sensitize us to plan more effective screening, preventive and management strategies. This will go long way to decrease morbidity and mortality in patients.

Mohamad Muzzafer Mir*, Mohamad Saleem Najar, Bipin Kumar Sharma, Mangit Singh, Ursilla Taranum Mir and Majid Khalil Rather

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