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. 2016 Aug;27(8):1204-14.
doi: 10.1016/j.jvir.2016.04.036. Epub 2016 Jun 16.

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

Paul P Heideman  1 , Mohammad Reza Rajebi  1 , Michael A McKusick  1 , Haraldur Bjarnason  1 , Gustavo S Oderich  2 , Jeremy L Friese  1 , Mark D Fleming  2 , Andrew H Stockland  1 , William S Harmsen  3 , Jay Mandrekar  3 , Sanjay Misra  4
Affiliations

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

Paul P Heideman et al. J Vasc Interv Radiol. 2016 Aug.

Abstract

Purpose: 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.

Materials and methods: 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.

Results: Patients with diabetes (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.3-3.6; P = .002) and runoff score of 0 or 1 (HR = 2.0; 95% CI, 1.2-3.4; 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 m(2) had a 17% increase in amputation for every 5-point decrease < 45 mL/min/1.73 m(2) (95% CI, 1.09-1.26; P < .001). Increase of 10 years in age (HR = 1.9; 95% CI, 1.5-2.3; P < .001), TransAtlantic Inter-Society Consensus class of C/D relative to A/B (HR = 1.6; 95% CI, 1.1-2.2; P = .01), and CLI (HR = 2.4; 95% CI, 0.5-0.9; P < .001) were associated with increased mortality. Female sex was associated with decreased risk of mortality (HR = 0.7; 95% CI, 0.5-0.9; P = .01).

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

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Conflict of interest statement

Conflict of Interest Disclosure Statement form: The authors have none.

Figures

Figure 1
Figure 1
Survival free estimate of all-cause mortality by CKD stage 1/2/3A, 3B/4, or 5
Figure 2
Figure 2
In CLI patients, smoothing spline of GFR for the outcome of MALE + POD
See this image and copyright information in PMC

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