Comparison of haemodialysis and non-haemodialysis patients in 6-year clinical outcomes after iliac artery stenting

Abstract

Background: Endovascular therapy (EVT) has become widely performed for peripheral artery disease (PAD) even in haemodialysis (HD) patients. In general population, favorable outcomes have been obtained after EVT for lesions of iliac artery. However, clinical outcomes after EVT for iliac artery lesions have not been fully evaluated in HD patients. We investigated the impact of HD on long-term outcome after iliac artery stenting. Methods: A total of 2096 patients undergoing successfully iliac artery stenting were enrolled from multi-center registry in Japan. Six-year clinical outcomes were compared between HD group (n=377) and non-HD (NHD) group (n=1719). Endpoint was defined as major adverse cardiovascular events (MACE) including death, myocardial infarction (MI) and stroke. Primary patency and major amputation were also analyzed. To reduce the differences of clinical and procedural characteristics between two groups, propensity score matching with all baseline variables was performed. Results: Prevalence of diabetes, coronary artery disease and critical limb ischemia (≥Rutherford grade IV) were higher in HD group than in NHD group. By Kaplan-Meier analysis, 6-year event-free survival rate from MACE was significantly lower in HD group than in NHD group (46.9% vs. 76.1%, p<0.0001). In addition, both primary patency rate and limb salvage rate were lower in HD group than in NHD group (64.2% vs. 75.1%, p=0.0004, and 96.7% vs. 99.3%, p=0.013, respectively). After propensity score analysis, survival rate from MACE was still lower in HD group than in NHD group [58.7% vs. 80.2%, hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.42-2.55, p<0.0001 for MACE and 61.6% vs. 85.7%, HR 1.91, 95% CI 1.43-2.56, p<0.0001 for mortality, respectively], and patency rate was also lower in HD group than in NHD group (65.0% vs. 77.9%, HR 1.34, 95% CI 1.00-1.80, p=0.047). Conclusion: Even after adjusting for clinical and procedural differences, HD was identified as an independent predictor of poor outcome after iliac artery stenting. Detection at the early stage of PAD is especially needed in this population.