Influence of Severe Chronic Kidney Disease on Outcomes of Endovascular Therapy for Peripheral Artery Disease

Abstract

Background: The influence of hemodialysis (HD) on limb salvage and survival in patients with peripheral artery disease (PAD) has been reported. However, whether severe chronic kidney disease (CKD) may increase the risk of outcomes in patients with PAD undergoing endovascular revascularization is unknown. In this present study, we evaluated the influence of CKD grade on outcomes, including amputation-free survival (AFS) and major adverse limb events (MALEs) + 30-day perioperative death (POD), after endovascular treatment (EVT) in patients with PAD. Methods: Only patients with primary intervention were included. The eGFR was calculated automatic for each patient and patients were then stratified into two groups for comparative analysis: those with severe CKD (classes 4 and 5; eGFR <30) vs. those with lesser degrees of low-grade CKD (eGFR ≥ 30). Results: Severe CKD was associated with a significantly higher proportion incidence of diabetes mellitus, HD, critical limb ischemia (CLI), and infrainguinal lesions. AFS and MALEs+POD were significantly better in low-grade CKD than in severe CKD. In multivariate analysis, showed that HD and CLI were found to negatively impact affects AFS. In multivariate analysis, only CLI was found to negatively affect MALEs+POD. Conclusions: The presence of severe CKD did not independently influence AFS and MALEs+POD. Appropriate revascularization should be considered in CKD patients before developing irreversible renal insufficiency.