CKD ups risk of mortality, complications in PAD patients on endovascular treatment
Chronic kidney disease (CKD) in peripheral artery disease (PAD) patients who have received endovascular treatment (EVT) increases the risk of short-term mortality and unexpected amputation, a recent study has found.
The study included 3,434 patients with 5,794 limbs whose lower extremity artery disease was treated with EVT. Of these, 272 (9.9 percent; mean age 70.83±9.00 years; 85.3 percent male) had CKD while 2,467 (90.1 percent; mean age 68.47±9.48; 83.4 percent male) had no CKD.
Rates of in-hospital deaths were significantly higher in patients with CKD than those without (4.4 percent vs 1.2 percent; p<0.001), as were the rates of unexpected amputation (0.7 percent vs 0.0 percent; p=0.028).
Kaplan-Meier curves showed that patients without CKD also had significantly better overall survival (p<0.001) and major adverse limb event (MALE)-free survival (ie, major and minor amputations, lack of reintervention; p<0.001) than patients who developed CKD.
Multivariate Cox proportional hazard analysis showed that aside from the presence of CKD (hazard ratio [HR], 2.844; 95 percent CI, 2.026–3.990; p<0.001), age (HR, 1.068; 1.050–1.085; p<0.001) and stroke history (HR, 1.568; 1.143–2.152; p=0.005) were significantly correlated with mortality. CKD was also significantly associated with MALE (HR, 1.631; 1.265–2.103; p<0.001).
Notably, the severity of CKD had no apparent effect on in-hospital events, procedural complications, and overall and event-free survival rates.
“These findings provide additive evidence that the presence of CKD should be considered as an important worse clinical risk factor in the aspect of not only short-term death and unexpected amputation, but also long-term mortality and MALE-free survival,” said researchers.