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BACKGROUND: Some evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease.METHODS: In this collaborative meta-analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium (baseline measurements obtained between 1972 and 2014) with baseline measurements of eGFR and albuminuria, at least 1000 participants (this criterion not applied to cohorts exclusively enrolling patients with chronic kidney disease), and at least 50 peripheral artery disease events, we analysed adult participants without peripheral artery disease at baseline at the individual patient level with Cox proportional hazards models to quantify associations of creatinine-based eGFR, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria with the incidence of peripheral artery disease (including hospitalisation with a diagnosis of peripheral artery disease, intermittent claudication, leg revascularisation, and leg amputation). We assessed discrimination improvement through c-statistics.FINDINGS: We analysed 817 084 individuals without a history of peripheral artery disease at baseline from 21 cohorts. 18 261 cases of peripheral artery disease were recorded during follow-up across cohorts (median follow-up was 7·4 years [IQR 5·7-8·9], range 2·0-15·8 years across cohorts). Both chronic kidney disease measures were independently associated with the incidence of peripheral artery disease. Compared with an eGFR of 95 mL/min per 1·73 m(2), adjusted hazard ratios (HRs) for incident study-specific peripheral artery disease was 1·22 (95% CI 1·14-1·30) at an eGFR of 45 mL/min per 1·73 m(2) and 2·06 (1·70-2·48) at an eGFR of 15 mL/min per 1·73 m(2). Compared with an ACR of 5 mg/g, the adjusted HR for incident study-specific peripheral artery disease was 1·50 (1·41-1·59) at an ACR of 30 mg/g and 2·28 (2·12-2·44) at an ACR of 300 mg/g. The adjusted HR at an ACR of 300 mg/g versus 5 mg/g was 3·68 (95% CI 3·00-4·52) for leg amputation. eGFR and albuminuria contributed multiplicatively (eg, adjusted HR 5·76 [4·90-6·77] for incident peripheral artery disease and 10·61 [5·70-19·77] for amputation in eGFR INTERPRETATION: Even mild-to-moderate chronic kidney disease conferred increased risk of incident peripheral artery disease, with a strong association between albuminuria and amputation. Clinical attention should be paid to the development of peripheral artery disease symptoms and signs in people with any stage of chronic kidney disease.FUNDING: American Heart Association, US National Kidney Foundation, and US National Institute of Diabetes and Digestive and Kidney Diseases.

Background Few studies evaluated associations of key measures of chronic kidney disease (CKD), estimated glomerular filtration rate (eGFR) and albuminuria, with incident lower-extremity peripheral artery disease (PAD). Thus, we aimed to quantify the independent and joint associations of these two CKD measures with incident PAD. Methods In 21 cohorts (801,731 participants) free of PAD at baseline, we quantified associations of creatinine-based eGFR, urine albumin-to-creatinine ratio [ACR], and dipstick proteinuria with incident PAD (including PAD hospitalization, intermittent claudication, leg revascularization, and leg amputation). Discrimination improvement was assessed through c-statistics. Findings There were 17,852 PAD cases across cohorts (a median follow-up ranging from 2.0-15.8 years across cohorts). Both CKD measures were independently associated with incident PAD. Adjusted hazard ratios (HRs) at eGFR 45 and 15 (versus 95) ml/min/1.73m2 were 1.22 (95%CI, 1.14-1.30) and 2.06 (1.70-2.48), respectively. Adjusted HRs at ACR 30 and 300 (versus 5) mg/g were 1.50 (1.41-1.59) and 2.28 (2.12-2.44), respectively. ACR-amputation association was particularly strong (HR at ACR 300 mg/g 3.68 [3.00-4.52]). eGFR and ACR contributed multiplicatively (e.g., adjusted HR 5.76 [4.90-6.77] mg/g for incident PAD and 10.61 [5.70-19.77] for amputation in eGFR Interpretation Even mild to moderate CKD conferred increased risk of incident PAD, with remarkable albuminuria-amputation relationship. Clinical attention should be paid to the development of PAD symptoms and signs in persons with any stages of CKD.

This paper explores the social worlds of older private and public renters in Sydney, Australia. Drawing on 56 in-depth interviews, it argues that the cost of accommodation and security of tenure played a pivotal role in shaping the social connections and leisure activity of the interviewees. It illustrates that in the case of the older renters interviewed who were dependent on the private rental market their minimal disposable income and constant anxiety around their tenure, meant that many could not afford to engage in leisure activities and did not have the desire or emotional capacity to do so. Many were isolated as a result. The older public housing interviewees, in contrast, because of their strong security of tenure, longevity of residence, low rents and the social composition of their accommodation had the desire, capacity and opportunity to engage in a range of pursuits and sustain strong social ties in the neighbourhood. The study suggests that providing affordable and secure housing can play a pivotal role in enhancing the capacity of older people to have strong social ties and engage in activities in and outside the neighbourhood.