Peripheral arterial disease (PAD) may increase the risks for infection-related hospitalization and death in kidney transplant recipients, investigators reported at Kidney Week 2021, a virtual meeting of the American Society of Nephrology.

Among 96,289 Medicare recipients who received a kidney transplant from 2006 to 2016 (median age 55 years; 38.7% female), those with vs without PAD had a significant 38% increased risk for infection-related hospitalization and death, Alex R. Dinh, MD, from the University of California San Francisco told Renal & Urology News in an interview. This risk was more pronounced in recipients of living than deceased-donor kidneys: 65% vs 34%. It was also higher among recipients younger than 60 years vs older: 43% vs 33%.

The top 5 infection-related diagnoses among individuals with PAD were urinary tract infections, sepsis, pneumonia, postoperative infections, and skin/soft tissue infections, he said.

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“There are multiple possible reasons for the increased risk for infections that we observed in individuals with PAD,” Dr Dinh explained. “PAD results in poor wound healing and increases the risk for lower extremity ulceration and gangrene. In addition, individuals with PAD may have decreased functional status, which can increase susceptibility to infections.”

Diabetes duration is another possible contributor but it could not be assessed. Of the cohort, 37.7% had diabetes.

All patients with advanced chronic kidney disease should be screened for PAD because it is a major risk factor for cardiovascular events and other complications, Dr Dinh said. Living-donor kidney transplant recipients and younger patients in particular may not have been evaluated for PAD, especially when assessment involved angiography. Both invasive and noninvasive screening methods are available, he noted.

“We hope that our study will increase recognition of PAD as a risk factor for infections after kidney transplant,” Dr Dinh said. “Furthermore, we hope that our work will lead to additional studies that prospectively evaluate whether earlier screening or more intensive management of PAD prior to transplant can reduce a transplant recipient’s risk of developing infections after transplant.”


Dinh A, Copeland TP, Mcculloch CE, Adey DB, Ku E. Peripheral arterial disease and risk of infection-related complications after kidney transplantation. Presented at: Kidney Week 2021; November 2-7, 2021. Oral presentation: PO2116.