Impact of severe chronic kidney disease on outcomes of infrainguinal peripheral arterial intervention

36Citations
Citations of this article
36Readers
Mendeley users who have this article in their library.

Abstract

Objective Patients with severe chronic kidney disease (CKD) and peripheral vascular disease are at increased risk of major adverse limb events (MALEs) and death; however, patients with end-stage renal disease have been excluded in current objective performance goals. We evaluated the effect of severe (class 4 and 5) CKD on outcomes after infrainguinal endovascular arterial interventions. Methods All primary peripheral vascular interventions (PVIs) performed at a single institution (January 2002 through December 2009) were included. End points were defined by Society for Vascular Surgery objective performance goals for critical limb ischemia (CLI), which include all-cause mortality, reintervention, and composite end points of death or amputation and MALEs (reintervention or amputation). Univariate and multivariable analysis was used to examine the effect of severe CKD on study end points. Results A total of 879 PVIs were performed, with severe CKD in 125 (14%). Severe CKD patients were significantly (P <.05) more likely to have diabetes (64% vs 46%), CLI (72% vs 11%), and need a multilevel PVI (34% vs 19%) or tibial intervention (35% vs 20%) compared with the remainder of the cohort. Distribution of TransAtlantic Inter-Society Consensus C and D lesions were similar (19% severe CKD vs 15%; P =.2). Severe CKD predicted perioperative (30-day) reintervention (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.5-4; P =.05), amputation or death (OR, 3.1; 95% CI, 1.1-9; P =.04), and MALEs (OR, 2.8; 95% CI, 1.3-6.1; P =.04), which was independent of CLI in multivariable regression analysis. On Kaplan-Meier analysis, severe CKD was significantly (log-rank P <.05) associated with death (31% ± 4% vs 7% ± 1%), amputation (14% ± 3% vs 3% ± 1%), and MALEs (40% ± 5% vs 26% ± 2%) at 1 year. Freedom from reintervention was similar at 1 year (70% ± 5% severe CKD vs 75% ± 2%; P =.23). Risk-adjusted (age, CLI, diabetes, coronary artery disease) Cox proportional hazards regression showed that severe CKD increased the risk of late mortality (hazard ratio [HR], 2.4; 95% CI, 1.8-3.2; P <.01), amputation (HR, 2.1; 95% CI, 1.1-3.9; P =.02), and death or amputation (HR, 1.8; 95% CI, 1.3-2.4; P =.04), without increasing the risk of late reinterventions or MALEs. Conclusions CKD independently predicts early and late adverse events after a PVI, in particular, excessive mortality. CKD should figure prominently in clinical decision making for patients with peripheral vascular disease. © 2014 by the Society for Vascular Surgery.

Cite

CITATION STYLE

APA

Patel, V. I., Mukhopadhyay, S., Guest, J. M., Conrad, M. F., Watkins, M. T., Kwolek, C. J., … Cambria, R. P. (2014). Impact of severe chronic kidney disease on outcomes of infrainguinal peripheral arterial intervention. In Journal of Vascular Surgery (Vol. 59, pp. 368–375). https://doi.org/10.1016/j.jvs.2013.09.006

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free