Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease

Abstract

PurposeTo evaluate effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE and postoperative death (MALE + POD), and amputation after endovascular treatment of femoropopliteal disease. Materials and MethodsA retrospective review from January 2002 to October 2011 was performed of 440 patients who underwent endovascular treatment of symptomatic femoropopliteal disease for claudication (n = 251) or critical limb ischemia (CLI) (n = 267). CKD stage was divided based on Kidney Dialysis Outcomes Quality Initiative classification. Outcomes and factors associated with amputation, MALE, and MALE + POD were determined. ResultsPatients with diabetes (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.3–3.6; P = .002) and runoff score of 0 or 1 (HR = 2.0; 95% CI, 1.2–3.4; P = .01) relative to runoff score of 3 were at increased risk of amputation. Patients with baseline glomerular filtration rate < 45 mL/min/1.73 m2 had a 17% increase in amputation for every 5-point decrease < 45 mL/min/1.73 m2 (95% CI, 1.09–1.26; P < .001). Increase of 10 years in age (HR = 1.9; 95% CI, 1.5–2.3; P < .001), TransAtlantic Inter-Society Consensus class of C/D relative to A/B (HR = 1.6; 95% CI, 1.1–2.2; P = .01), and CLI (HR = 2.4; 95% CI, 0.5–0.9; P < .001) were associated with increased mortality. Female sex was associated with decreased risk of mortality (HR = 0.7; 95% CI, 0.5–0.9; P = .01). ConclusionsWorsening CKD is associated with higher amputation rates, all-cause mortality, and MALE + POD in patients undergoing endovascular treatment of femoropopliteal disease.