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. 2025 May 21;25(1):388.
doi: 10.1186/s12872-025-04838-x.

Systemic outcomes of symptomatic peripheral artery disease patients with end-stage renal disease undergoing lower limb endovascular treatment: a propensity score-matched analysis

Shang-Yu Tsai  1   2 , Tzu-Yen Huang  1 , Han-Yan Li  1 , Shun-Ying Yin  1 , Tzu-Ping Chen  1 , Yao-Chang Wang  1 , Chi-Hsiao Yeh  3   4   5   6
Affiliations

Systemic outcomes of symptomatic peripheral artery disease patients with end-stage renal disease undergoing lower limb endovascular treatment: a propensity score-matched analysis

Shang-Yu Tsai et al. BMC Cardiovasc Disord. .

Abstract

Background: This study investigates the impact of end-stage renal disease (ESRD) on systemic and localized outcomes in peripheral artery disease (PAD) patients following endovascular therapy (EVT), with a focus on major adverse cardiac and cerebrovascular events (MACCEs).

Methods: This retrospective cohort study included symptomatic PAD patients, categorized by the Rutherford classification, who underwent EVT at a single tertiary medical center from May 2018 to May 2021. Patients were divided into ESRD and non-ESRD groups. A propensity score-matched (PSM) analysis was performed to minimize confounding factors. The primary outcome was the occurrence of MACCEs, while the secondary outcome was the incidence of major adverse limb events (MALEs).

Results: ESRD patients exhibited significantly worse systemic outcomes, with higher MACCE rates compared to non-ESRD patients in both the entire cohort (79.9% vs. 39.9%; HR: 2.69; 95% CI: 1.80-4.02; p < 0.001) and the matched cohort (HR: 3.88; 95% CI: 2.30-6.53; p < 0.001). They also had higher rates of all-cause mortality and myocardial infarction (MI). For localized outcomes, MALEs were more frequent in the ESRD group in the entire cohort (61.0% vs. 34.9%; HR: 1.84; 95% CI: 1.22-2.76; p < 0.001), but no significant difference was observed in the matched cohort (HR: 1.23; 95% CI: 0.76-1.99; p = 0.40). ESRD was identified as the sole independent predictor of increased MACCE risk (HR: 2.49; 95% CI: 1.65-3.75; p < 0.001).

Conclusions: PAD patients with ESRD face significantly worse systemic outcomes, particularly elevated MACCE rates, after EVT. Preventing MACCEs, especially MI, is essential in this high-risk population. Despite more severe limb conditions, ESRD alone did not significantly increase MALE risk after PSM.

Clinical trial number: Not applicable.

Keywords: End-Stage renal disease; Endovascular interventions; MACCEs; MALEs; Peripheral artery disease; Systemic outcomes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study adhered to the ethical guidelines of the 1975 Declaration of Helsinki. It was reviewed and approved by the Institutional Review Board of Chang Gung Medical Foundation (Institutional Review Board of Chang Gung Medical Foundation, IRB No: 202201849B0), which waived the need for an informed consent statement. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curves for MACCEs: non-ESRD versus ESRD. (A) entire population survival curves (B) propensity score-matched survival curves. CI = confidence interval; ESRD = end-stage renal disease; EVT = endovascular treatment; HR = hazard ratio; MACCEs = major adverse cardiac and cerebrovascular events
Fig. 2
Fig. 2
Kaplan-Meier survival curves for MALEs: non-ESRD versus ESRD. A. entire population survival curves B. propensity score-matched survival curves. CI = confidence interval; ESRD = end-stage renal disease; EVT = endovascular treatment; HR = hazard ratio; MALEs = major adverse limb events
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