Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease

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• 作者：Paul P. Heideman ; MD^a ; Mohammad Reza Rajebi ; MD^a ; Michael A. McKusick ; MD^a ; Haraldur Bjarnason ; MD^a ; Gustavo S. Oderich ; MD^b ; Jeremy L. Friese ; MD^a ; Mark D. Fleming ; MD^b ; Andrew H. Stockland ; MD^a ; William S. Harmsen ; MS^c ; Jay Mandrekar ; PhD^c ; Sanjay Misra ; MD^a ; ^d ; ^{misra.sanjay@mayo.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ABI ; ankle-brachial index ; CI ; confidence interval ; CKD ; chronic kidney disease ; CLI ; critical limb ischemia ; GFR ; glomerular filtration rate ; HR ; hazard ratio ; MALE ; major adverse limb event ; MALE + POD ; major adverse limb events and postoperative death ; PAD ; peripheral arterial disease ; POBA ; plain old balloon angioplasty ; TASC ; TransAtlantic Inter-Society Consensus
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：27
• 期：8
• 页码：1204-1214
• 全文大小：376 K

文摘

To evaluate effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE and postoperative death (MALE + POD), and amputation after endovascular treatment of femoropopliteal disease.

<h4 id="absSec_2">Materials and Methodsh4>

A retrospective review from January 2002 to October 2011 was performed of 440 patients who underwent endovascular treatment of symptomatic femoropopliteal disease for claudication (n = 251) or critical limb ischemia (CLI) (n = 267). CKD stage was divided based on Kidney Dialysis Outcomes Quality Initiative classification. Outcomes and factors associated with amputation, MALE, and MALE + POD were determined.

<h4 id="absSec_3">Resultsh4>

Patients with diabetes (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.3&ndash;3.6; P = .002) and runoff score of 0 or 1 (HR = 2.0; 95% CI, 1.2&ndash;3.4; P = .01) relative to runoff score of 3 were at increased risk of amputation. Patients with baseline glomerular filtration rate < 45 mL/min/1.73 m² had a 17% increase in amputation for every 5-point decrease < 45 mL/min/1.73 m² (95% CI, 1.09&ndash;1.26; P < .001). Increase of 10 years in age (HR = 1.9; 95% CI, 1.5&ndash;2.3; P < .001), TransAtlantic Inter-Society Consensus class of C/D relative to A/B (HR = 1.6; 95% CI, 1.1&ndash;2.2; P = .01), and CLI (HR = 2.4; 95% CI, 0.5&ndash;0.9; P < .001) were associated with increased mortality. Female sex was associated with decreased risk of mortality (HR = 0.7; 95% CI, 0.5&ndash;0.9; P = .01).

<h4 id="absSec_4">Conclusionsh4>

Worsening CKD is associated with higher amputation rates, all-cause mortality, and MALE + POD in patients undergoing endovascular treatment of femoropopliteal disease.