Effect of Chronic Kidney Disease on Mortality in Patients Undergoing Lower Extremity Peripheral Vascular Intervention

• Published in: The American journal of cardiology
• Main Authors: Xie, Joe X., MD, Glorioso, Thomas J., MS, Dattilo, Philip B., MD, Aggarwal, Vikas, MD, Ho, P. Michael, MD, Barón, Anna E., PhD, Donaldson, Darcy, RN, Armstrong, Ehrin J., MD, MSc, Klein, Andrew, MD, Giri, Jay, MD, Tsai, Thomas T., MD
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Cardiovascular; Peripheral artery disease; Peripheral vascular intervention; Chronic kidney disease
• ISSN: 0002-9149
• DOI: 10.1016/j.amjcard.2016.10.053

Abstract It is known that chronic kidney disease (CKD) is associated with increased postoperative morbidity and mortality among peripheral artery disease (PAD) patients undergoing lower extremity surgical revascularization; however, outcomes after peripheral vascular intervention (PVI) are less well established. This study sought to determine the impact of CKD on adverse outcomes among patients with PAD undergoing PVI. Using data from the VA Clinical Assessment, Reporting, and Tracking System (CART) Program, we identified a cohort of 755 patients undergoing lower extremity PVI between June 2005 and August 2010 at 33 sites. The outcomes of interest were mortality, progression to dialysis, myocardial infarction (MI), limb amputation, and stroke. Kaplan-Meier survival analysis and Cox proportional hazard frailty models assessed the association between CKD and adverse outcomes. Among patients undergoing lower extremity PVI, 201 (27%) patients had CKD. The presence of CKD was associated with decreased survival (5-year survival probability of CKD compared to non-CKD: 49.9% [41.6%-59.9%] versus 80.1% [76.2%-84.1]), which persisted after risk adjustment (HR 1.57; 1.13-2.19). In addition, there was a significant association between CKD and progression to dialysis (HR 6.62; 2.25-19.43). In contrast, there was no association between CKD and re-hospitalization for MI, limb amputation, or stroke. In conclusion, CKD is present in 1 in 4 patients undergoing PVI and is associated with increased risk of mortality and progression to dialysis.