Peripheral artery disease (PAD), a condition where blood vessels in the legs and feet narrow and harden, is dramatically more common in people with chronic kidney disease (CKD) than the general population, and it carries severe consequences including amputation and death. A large study of over 450,000 Canadian adults found that 30% of people with advanced kidney disease had PAD, compared to just 10% of those with normal kidney function.

What Is the Connection Between Kidney Disease and Circulation Problems?

Kidney disease and PAD share common risk factors, particularly diabetes and high blood pressure, which damage blood vessels throughout the body. When kidneys fail to filter waste effectively, harmful substances accumulate in the bloodstream, accelerating the hardening and narrowing of arteries in the legs and feet. This creates a dangerous double threat: people with both conditions face compounding health risks that multiply their chances of serious complications.

The research, published in the American Journal of Kidney Diseases, examined 453,573 adults with at least one kidney function measurement between 2007 and 2014. Among those with PAD, 30% had moderate to advanced kidney disease, and 3.1% were on dialysis. By contrast, in the group without PAD, only 10.1% had moderate to advanced kidney disease, and just 0.4% were on dialysis.

How Severe Are the Complications for Kidney Patients With PAD?

The consequences of having both conditions are stark. Patients with advanced kidney disease on dialysis who also have PAD face a 12-fold increased risk of foot ulcers, gangrene, and amputation compared to those without PAD. Even among people with moderate kidney disease, the risk of lower-limb complications jumps 6.6-fold when PAD is present.

These aren't minor complications. Foot ulcers can lead to infections, gangrene, and ultimately amputation, which devastates quality of life and increases healthcare costs significantly. The study found that crude rates of lower-limb complications in dialysis patients reached 74.9 cases per 1,000 patient-years for those with PAD, compared to 40.5 cases per 1,000 patient-years for those without it.

Beyond limb complications, PAD also increases the risk of heart attacks and strokes. In people with normal kidney function, PAD raised the risk of cardiovascular events by 56%. The presence of PAD also increased the risk of death from any cause by 24% in this group.

Steps to Protect Your Circulation if You Have Kidney Disease

• Regular Screening: Ask your nephrologist about screening for PAD, especially if you have advanced kidney disease or are on dialysis. Early detection allows for preventive treatment before complications develop.
• Blood Pressure Control: Keep your blood pressure at target levels, as high blood pressure is a major driver of both kidney disease and artery damage. Work with your healthcare team to achieve recommended targets.
• Foot Care and Monitoring: Check your feet daily for sores, discoloration, or signs of poor circulation. Wear comfortable shoes and avoid walking barefoot, as neuropathy (nerve damage) from kidney disease can mask pain from developing ulcers.
• Medication Adherence: Take all prescribed medications for blood pressure, cholesterol, and kidney disease as directed, since these help slow both kidney decline and arterial damage.

Researchers emphasized that patients on dialysis with PAD should be considered at extreme risk and deserve priority for screening and treatment strategies. "PAD is common in patients with CKD G3-G5 or CKD G5D and is a potent risk factor for cardiovascular events, lower-limb complications, and death," the study authors concluded.

Why Isn't This Connection Better Known?

Despite the severity of these complications, there has been limited research on how PAD affects kidney disease patients who are not yet on dialysis. Most prior studies focused on dialysis patients, leaving a gap in understanding the broader population with moderate kidney disease. This new research fills that gap by showing that PAD poses serious risks across all stages of kidney disease, not just the most advanced stages.

The study did note some limitations, including reliance on hospital discharge codes rather than direct clinical assessment, which may have missed some cases. Additionally, the cohort was predominantly white and Canadian, so results may not fully apply to other populations. However, the large sample size and consistent findings across multiple analyses strengthen confidence in the results.

For the estimated 37 million Americans with chronic kidney disease, many of whom don't know they have it, understanding the link between kidney health and circulation is critical. If you have been diagnosed with kidney disease, diabetes, or high blood pressure, discussing PAD screening with your doctor could help prevent serious complications before they develop.