As the ninth leading cause of death in the United States, and a condition that affects an estimated 26 million Americans, chronic kidney disease is a growing health epidemic that creeps in silently, but can quickly manifest in deafening ways. While kidney disease is widely recognized and understood by patients, it’s equally as important to focus on related disease conditions.

Perhaps one of the most devastating impacts of CKD—and one we don’t hear about nearly enough—are complications associated with CKD and cardiovascular disease, particularly peripheral artery disease (PAD) and resulting limb amputation. Leading factors for both CKD and PAD are hypertension and diabetes, underscoring the multiple health risks patients face when diagnosed with these chronic conditions.

Research has further shown that Americans with CKD are at a higher risk than the general population of developing PAD, which causes narrowing or blockage of the vessels that carry blood from the heart to the legs. Poor circulation not only causes excruciating pain, but can lead to tissue death and complex, untreatable ulcers.

Vascular disease—including PAD—is now responsible for 80% of all amputations. Undergoing an amputation due to advanced PAD is both physically and emotionally devastating. It can be a source of lifelong pain, impact a patient’s quality of life, and the ability to work and function independently. Amputations also bring enormous costs to the health care system—an estimated $10.6 billion annually.

But the news for CKD patients with PAD isn’t all bad. Current technologies are available that can help reverse some of the most devastating symptoms. Outpatient interventions like angiography, revascularization (which restores critical blood flow to affected limbs), and atherectomy (a minimally invasive endovascular technique that removes plaque from blood vessels), have helped decrease the incidence of major amputations by 75%.

The benefits of this type of care can be nothing short of life-changing. With access to a PAD specialist and appropriate intervention, patients can enjoy reduced pain, enhanced mobility, improved quality of life, and a better outlook overall. In fact, the mortality rate for those who avoid amputation drops to just 16–24% compared to 48-71% for those who undergo an amputation.

This data underscores the need for public policies that increase access to PAD diagnosis and intervention, particularly among older Americans dependent on Medicare to access care, and who are often living with multiple comorbidities common across this population, including diabetes and hypertension. Other important factors impacting both CKD and PAD patient groups are the racial disparities that exist, which show African and Hispanic Americans are at a measurably higher risk for both diseases conditions.

For CKD patients diagnosed with PAD, the critical importance of appropriate and timely clinical intervention cannot be overstated. Unfortunately, there are a host of challenges affecting this population, including delayed vascular specialist referral, and slow PAD treatment initiation. Furthermore, studies have shown that patients with CKD are less likely to be provided recommended “optimal” PAD care.

Combatting the silent devastation that comes with CKD means educating Americans about their risk factors and working to provide the very best care possible to help avoid CKD’s most serious complications. Better access to PAD treatment to ensure limb preservation is central to this effort.