Impact of Peripheral Vascular Disease on Mortality in Wait Listed Dialysis Patients and Recipients of a First Kidney Transplant.

Abstract

Introduction: There is lack of information whether waitlisted dialysis patients with peripheral vascular disease (PVD) benefit from kidney transplantation. Methods: We used a cohort of USRDS incident dialysis patients from 2001 to 2007, with follow-up through 2008. Patients with PVD and under the age of 70 were included and divided into three groups; PVD patients on dialysis, waitlisted and PVD patients who received a first transplant (deceased or living). We calculated the mean comorbidity risk score (CRS) to determine differences in health status inpatients on dialysis, waitlist and at transplantation. CRS comprised of history of diabetes mellitus, hypertension, hypercholesterolemia, myocardial infarction, cerebrovascular disease and age greater than 55 years, by assigning a value of 1 to each comorbidity at the time first service. The primary outcome was all cause mortality. Standardized Mortality Ratios (SMR) and hazard ratios of death were calculated for statistical comparisons between the 3 groups. Results: 23,699 incident dialysis patients met inclusion criteria; only 16.7% (n=3964) were waitlisted, of which 8.9 % (n=2121) were transplanted. The annual death rates per 100 patient years was 22.86 in PVD patients on dialysis, 4.98 in waitlisted PVD patients and 4.86 in kidney transplant recipients. There was significant differences in mean co-morbidity risk score (2.38± 0.018 vs. 2.30 ±0.020 p=0.003) but not in adjusted hazard ratio 1.10 (95% CI 0.89-1.33, p=0.41) vs. 1.05 (95% CI 0.79-1.39, p=0.75) between waitlisted and transplanted patients with PVD. Figure 1 shows patient survival in PVD patients.Figure: No Caption available.Conclusions: There was no survival advantage of transplantation compared to remaining on the waitlist in PVD patients.