Chronic kidney disease and the short-term risk of mortality and amputation in patients hospitalized for peripheral artery disease

Abstract

Objective: The aim of the present study was to determine the prevalence of chronic kidney disease (CKD) and its prognostic value in patients hospitalized for lower extremity peripheral artery disease (PAD).

Methods: Data from the COhorte des Patients ARTériopathes registry, a prospective multicenter, observational study of consecutive patients hospitalized for PAD in academic hospitals of southwestern France, were analyzed. All the subjects were in Rutherford grade ≥ 3, and 55.6% were in grade ≥ 5-6. Associations between CKD and 1-year mortality, as well as amputation rates, were evaluated by Cox analysis. Kaplan-Meier survival curves were analyzed according to estimated glomerular filtration rate (eGFR).

Results: From May 2004 to January 2009, we enrolled 1010 patients. They were classified into four groups according to the eGFR: 21.7% were in group 1 (≥ 90 mL/min per 1.73 m(2)), 34% in group 2 (60-89 mL/min per 1.73 m(2)), 32.2% in group 3 (30-59 mL/min per 1.73 m(2)), and 12.1% in group 4 (<30 mL/min per 1.73 m(2) including dialysis). All-cause mortality was 25.1% at 1 year. The rate of major amputation was 26.3%. Mortality rates were, respectively, at 16%, 18%, 31.7%, and 44.3% (P < .0001) in groups 1 to 4. The major amputation rates were at 23.7%, 21.5%, 28%, and 40.2% (P = .0006), respectively. The presence of severe CKD (group 4) was associated with all-cause mortality (hazard ratio, 1.84; 95% confidence interval, 1.02-3.32; P = .044). In contrast, the risk of amputation was not associated with CKD after adjustments to risk factors.

Conclusions: The prevalence of CKD in patients hospitalized for PAD is high. CKD is an independent predictor of 1-year mortality, but is not an independent predictor of limb amputation.