Kidney Transplantation Reduces the Risk of Critical Limb Ischemia and/or Amputation Among Patients With End-stage Renal Disease on Hemodialysis

Abstract

Introduction: The objective of the study was to analyze the risk of critical limb ischemia and/or amputation among patients with end-stage renal disease (ESRD) entering a hemodialysis (HD) program and to evaluate the possible protective effect associated with kidney transplantation. Methods: Retrospective cohort including all ESDR patients that started on HD program at our institution between 2000 and 2010. Collected variables included baseline characteristics (pre-entry in hemodialysis), time on HD program, kidney transplantation and the development of critical limb ischemia and/or need for minor or major amputation. Patients with previous symptomatic peripheral arterial disease or amputation were excluded. Statistics: Cox regression model adjusted for all variables related to 1) critical limb ischemia and/or minor/major amputation and 2) renal transplantation. Results: The study group included 336 patients (mean age = 63 years, 221 (66 %) male). The mean follow up was 6, 7 years, with an average time on HD of 4,2 years, and 92 patients (27,4 %) underwent transplantation. Critical limb ischemia and/or amputation free survival rates were 88,6 % and 79,6 % at 5 and 10 years, respectively. The mean follow-up was 6.5 years, and 22 revascularization procedures for critical limb ischemia, 26 minor amputations and 18 major amputations were performed. Kidney transplantation was associated with a protective effect over the development of critical limb ischemia and/or amputation (HR: 0,065; p: < 0,001), after adjustment for diabetes mellitus (HR: 7,316; p< 0,001), a total cholesterol < 125mg/ml (HR: 2,538; p=0,003), time on HD (HR: 1,000; p: 0,003) and male gender (HR: 2,109; p: 0,040). Long-term survival rates of the cohort were 56,8 % and 32,7 % at 5 and 10 years respectively, but decreased to 47 % at 1 year and 18.2 % at 5 years once critical limb ischemia and/or amputation occurred. Conclusion: Patients on HD program show a notorious risk of critical limb ischemia and/or amputation over time. Once this complication occurs patient's survival is markedly reduced. Transplantation confers an independent protective effect over the development of critical limb ischemia and/or amputation. Disclosure: Nothing to disclose