Chronic kidney disease and outcomes of lower extremity revascularization for peripheral artery disease

Document Type

Journal Article

Publication Date

3-1-2020

Journal

Atherosclerosis

Volume

297

DOI

10.1016/j.atherosclerosis.2019.12.016

Keywords

Chronic kidney disease; Endovascular; Hospital readmission; lower extremity revascularization; Outcomes; Peripheral artery disease; Renal disease; Surgery

Abstract

Background & aims: Renal disease is a risk factor for peripheral artery disease (PAD), yet its impact on outcomes after lower extremity (LE) revascularization is not well established. We aimed to characterize the association between chronic kidney disease (CKD) and/or end stage renal disease (ESRD) and post-procedural outcomes in PAD patients undergoing LE revascularization in the United States. Methods: Adults age ≥18 years undergoing surgical or endovascular LE revascularization for PAD with and without CKD or ESRD were identified from the 2014 Nationwide Readmissions Database. Major adverse cardiovascular events (MACE), defined as a composite of death, myocardial infarction or ischemic stroke, were identified for patients with and without renal disease. All-cause hospital readmissions within 6 months of discharge were determined for all survivors. Results: Among 39,441 patients with PAD hospitalized for LE revascularization, 10,530 had renal disease (26.7%), of whom 69% had CKD without ESRD and 31% had ESRD. Patients with renal disease were more likely to have MACE after LE revascularization (5.2% vs. 2.5%; adjusted OR [aOR] 1.74, 95% CI 1.40–2.16), require LE amputation (26.1% vs. 12.2%; aOR 1.33, 95% CI 1.19–1.50), and require hospital readmission within 6 months (61.0% vs. 43.6%; adjusted HR [aHR] 1.38, 95% CI 1.28–1.48) compared to those without renal disease. Conclusions: Renal disease is common among patients undergoing LE revascularization for PAD and was independently associated with in-hospital MACE, LE amputation, and hospital readmission within 6 months. Additional efforts to improve outcomes of patients with renal disease and PAD requiring LE revascularization are necessary.

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