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2015 ; 94
(24
): e948
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Elevated Blood Urea Nitrogen is Associated With Critical Limb Ischemia in
Peripheral Arterial Disease Patients
#MMPMID26091458
Gary T
; Pichler M
; Schilcher G
; Hafner F
; Hackl G
; Rief P
; Eller P
; Brodmann M
Medicine (Baltimore)
2015[Jun]; 94
(24
): e948
PMID26091458
show ga
As renal function is often impaired in atherosclerosis patients, accelerating
atherosclerosis per se and creating a vicious cycle, we investigated the
association of blood urea nitrogen (BUN) and critical limb ischemia (CLI) in
peripheral arterial occlusive disease (PAOD) patients. Our cross-sectional study
included 1521 PAOD patients, with normal and impaired renal function treated at
our institution from 2005 to 2010. Patients on renal replacement therapy were
excluded. The cohort was divided into tertiles according to the serum BUN levels.
An optimal cutoff value for the continuous BUN was calculated by applying a
receiver-operating curve analysis to discriminate between CLI and non-CLI. In our
cohort, CLI increased significantly with an increase in BUN (13.1% in the first
tertile, 18.7% in the second tertile, 29.0% in the third tertile, P for trend <
0.001). A BUN of 17.7 ?mg/dL was identified as an optimal cutoff. Accordingly,
there were 2 groups of patients: 636 patients with BUN ? 17.7 and 885 patients
with BUN > 17.7. CLI was more frequent in BUN > 17.7 patients (342 [38.6%]) than
in BUN? ? 17.7 patients (134 [21.1%]) (P < 0.001); the same applied to prior
myocardial infarction (45 [5.1%] vs 15 [2.4%], P = 0.007) and congestive heart
failure (86 [9.7%] vs 31 [4.9%], P < 0.001). A BUN > 17.7 was associated with an
odds ratio of 1.6 (95% confidence interval: 1.3-1.9, P < 0.001) for CLI even
after the adjustment for other established vascular risk factors such as age ? 75
and type 2 diabetes. An increased BUN is significantly associated with a high
risk for CLI and other vascular endpoints. The BUN is an easily determinable,
broadly available, and inexpensive marker that could be used to identify patients
at high risk for vascular endpoints.