In-hospital outcomes in patients with critical limb ischemia and end-stage renal disease after revascularization

Abstract

Analysis of in-hospital outcomes in patients treated for critical limb ischemia (CLI) and end-stage renal disease (ESRD) compared to CLI patients with normal renal function. A subgroup analysis of the German CRITISCH registry, a prospective multicenter registry, assessing the first-line treatment strategies in CLI patients in 27 vascular centers in Germany was performed. The study cohort wasdivided into ESRD patients (n= 102) and patients with normal renal function (n= 674; glomerular filtration rate>60/mL/min/1.73m(2)). The following first-line treatment strategies were assessed: endovascular therapy (EVT), bypass surgery, patch plasty, and no vascular intervention (conservative treatment, primary amputation). Uni- and multivariate analyses were performed to identify differences between groups as to six end points: amputation or death (composite end point), amputation, death, hemodynamic failure, major adverse cardiac and cerebrovascular events, and reintervention. Differences between the ESRD and non-ESRD group were found regarding the applied first-line therapy (P=.016): The first-line treatment strategies in ESRD patients were EVT in 64% (n= 65), bypass surgery in 13% (n=13), patch plasty in 11% (n= 11), and no vascular intervention in 13% (n= 13). In non-ESRD patients, EVT was applied in 48% (n= 326), bypass surgery in 27% (n= 185), patch plasty in 13% (n= 86), and no vascular intervention in 11% (n= 77). For ESRD patients, a noticeably increased risk of the composite end point (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.19-5.79; P= .017), amputation (OR, 3.14; 95% CI, 1.35-7.31; P= .008), and hemodynamic failure (OR, 2.19; 95% CI, 1.19-4.04; P= .012) was observed. CLI patients on dialysis represent a challenging cohort prone to in-hospital death, amputation, and hemodynamic failure. Two-thirds of these high-risk patients are treated with EVT. Present data suggest that this modality is generally considered as the most favorable treatment option in this patient subgroup.