Alprostadil treatment of critical limb ischemia in hemodialysis patients : Aretrospective single-center analysis.

Abstract

Peripheral artery disease and critical limb ischemia are common in patients undergoing chronic hemodialysis treatment and are associated with ahigh rate of amputation and mortality. The effect of treatment with prostanoids in this specific group of patients is unknown. Aretrospective single-center analysis of hemodialysis patients with critical limb ischemia was performed who were treated with the prostanoid analogue alprostadil as an infusion during hemodialysis in the period from 2000 to 2013. The primary study outcome was acombined end-point including amputation and death 1year after start of alprostadil. Kaplan-Meier curves were used to describe amputation-free survival and overall survival. Amultivariable adjusted Cox proportional hazards model was calculated for the primary outcome. Atotal of 86patients (60males, 69.7%) were studied. The median alprostadil treatment period was 1.8months. The 1‑year amputation-free survival was 41%. In 36% of patients an amputation was necessary and 35% died. Despite alprostadil treatment, 36% of the study patients additionally underwent an endovascular procedure and 16% had bypass surgery. Men had asignificantly higher amputation rate (45%) than women (15%) (P = 0.009). Male sex and dialysis vintage were significantly associated with an increased risk for primary outcome CONCLUSIONS: Despite treatment with alprostadil the mortality, amputation rate and the need for revascularization procedures in hemodialysis patients with critical limb ischemia remained high. The outcome, however, was comparable with that of other treatment, such as endovascular procedures and bypass surgery. The effect of any current treatment strategy on amputation rate or mortality in that patient group remains uncertain.