Routinely Measured Serum Biomarkers and Peripheral Artery Disease in Patients Undergoing Maintenance Dialysis: A Systematic Review and Meta-Analysis.

BACKGROUND

Patients on maintenance dialysis have a markedly elevated prevalence of peripheral artery disease (PAD), which can be independently related to mortality and cardiovascular events. Although routine serum parameters are widely available in dialysis care, the studies comparing them between patients with and without PAD have demonstrated inconsistent results. This systematic review and meta-analysis aims to quantify biomarker differences and resolve the discrepancies.

METHODS

Following the PRISMA guidelines, unrestricted language searches were performed in PubMed, Scopus, and Web of Science for studies comparing routine serum biomarkers between dialysis patients with and without PAD. Random-effects meta-analyses were conducted for albumin, CRP, PTH, calcium, phosphate, total cholesterol, LDL, HDL, and triglycerides to calculate standardized mean difference (SMD) or means ratio. Heterogeneity was explored by meta-regression and sensitivity analyses.

RESULTS

Twenty-four studies (33,052 patients; 8,462 with PAD) were included. Serum albumin was significantly lower in PAD patients (SMD: -0.34; 95% CI: -0.48 to -0.20). CRP trended toward elevation without reaching significance. Also, PTH, calcium, phosphate, total cholesterol, LDL, and HDL showed no meaningful differences. Sensitivity analyses and meta-regression confirmed robustness of all estimates. No publication bias was detected.

CONCLUSIONS

Among routinely measured serum biomarkers, only albumin was significantly associated with PAD in dialysis patients, consistent with the malnutrition-inflammation-atherosclerosis framework. As evidence is predominantly retrospective, these findings reflect correlates of established PAD rather than confirmed predictors of onset, supporting their use to prompt earlier clinical screening. Prospective studies with adjusted analyses are needed to clarify the roles of inflammatory and mineral metabolism markers.