Relation of Baseline Renal Dysfunction With Outcomes in Patients Undergoing Popliteal and Infrapopliteal Percutaneous Peripheral Arterial Interventions

Parvataneni, Kesav; Piyaskulkaew, Chatchawan; Szpunar, Susan; Sharma, Tarun; Patel, Vishal; Patel, Saurabhkumar; Davis, Thomas P.; LaLonde, Thomas; Yamasaki, Hiroshi; Rosman, Howard; Mehta, Rajendra H.

doi:10.1016/j.amjcard.2016.04.029

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…There is an abundance of clinical and epidemiological data demonstrating that CKD is linked to worsened health outcomes in PAD patients 3,5–9,11,12,43 , however the biological mechanisms are not known. In this study, CLI patients with CKD displayed worsen ischemic myopathy characterized by reduced myofiber cross sectional area and a marked decreased in skeletal muscle mitochondrial respiratory function.…”

Section: Discussionmentioning

confidence: 99%

“…CKD also increases the likelihood that patients will present with ischemic ulceration or gangrene which substantially increases the risk of limb amputation 4,10,11 . In addition to increasing risk of mortality and amputation, CKD also increases the failure rate of endovascular/revascularization surgical interventions in PAD 3,12,13 . Complicating the mortality and surgical failure risk, administration of contrast dyes during endovascular/revascularization surgeries has been shown to induce acute kidney injury that increases future risk of developing CKD 14,15 .…”

Section: Introductionmentioning

confidence: 99%

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Chronic kidney disease exacerbates ischemic limb myopathy in mice via altered mitochondrial energetics

Berru¹,

Gray²,

Thome³

et al. 2019

Sci Rep

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Chronic kidney disease (CKD) substantially increases the severity of peripheral arterial disease (PAD) symptomology, however, the biological mechanisms remain unclear. The objective herein was to determine the impact of CKD on PAD pathology in mice. C57BL6/J mice were subjected to a diet-induced model of CKD by delivery of adenine for six weeks. CKD was confirmed by measurements of glomerular filtration rate, blood urea nitrogen, and kidney histopathology. Mice with CKD displayed lower muscle force production and greater ischemic lesions in the tibialis anterior muscle (78.1 ± 14.5% vs. 2.5 ± 0.5% in control mice, P < 0.0001, N = 5–10/group) and decreased myofiber size (1661 ± 134 μm2 vs. 2221 ± 100 μm2 in control mice, P < 0.01, N = 5–10/group). This skeletal myopathy occurred despite normal capillary density (516 ± 59 vs. 466 ± 45 capillaries/20x field of view) and limb perfusion. CKD mice displayed a ~50–65% reduction in muscle mitochondrial respiratory capacity in ischemic muscle, whereas control mice had normal mitochondrial function. Hydrogen peroxide emission was modestly higher in the ischemic muscle of CKD mice, which coincided with decreased oxidant buffering. Exposure of cultured myotubes to CKD serum resulted in myotube atrophy and elevated oxidative stress, which were attenuated by mitochondrial-targeted therapies. Taken together, these findings suggest that mitochondrial impairments caused by CKD contribute to the exacerbation of ischemic pathology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease exacerbates ischemic limb myopathy in mice via altered mitochondrial energetics

Berru¹,

Gray²,

Thome³

et al. 2019

Sci Rep

View full text Add to dashboard Cite

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“…After adjusting for patients' demographics, clinical presentation (intermittent claudication vs. CLI), comorbidities, insurance and socioeconomic status using multivariate regression mode, ESRD patients on dialysis remained at higher risk of in‐hospital mortality (adjusted OR: 2.13 [95% CI: 2.04–2.23]; Table ). Risk‐adjusted linear regression for LOS demonstrated a statistically significant longer LOS in the ESRD dialysis group (median LOS = 7 days; Interquartile range [IQR]) when compared with those with normal kidney function (median LOS = 3 days; [IQR; 0–6]; p < .001).…”

Section: Resultsmentioning

confidence: 99%

“…Prior studies showed that as renal function declines, patients are less likely to receive revascularization and more likely to have an amputation or no intervention due to severity of their disease precluding further interventions . In one study, PVI in ESRD was shown to be associated with higher mortality and amputation . However, the study included a small number of patients undergoing infra‐popliteal PVI and focused only on limb outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 In one study, PVI in ESRD was shown to be associated with higher mortality and amputation. 12 However, the study included a small number of patients undergoing infra-popliteal PVI and focused only on limb outcomes. To the best of our knowledge, there are no large cohort studies that evaluated in-hospital adverse cardiovascular outcomes in ESRD patients undergoing below and above the knee PVI.…”

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confidence: 99%

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In‐hospital outcome of peripheral vascular intervention in dialysis‐dependent end‐stage renal disease patients

Pacha

Al‐Khadra

Darmoch

et al. 2019

Cathet Cardio Intervent

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Background The impact of end‐stage renal disease (ESRD) on peripheral vascular intervention (PVI) outcome remains incompletely elucidated. Objectives We sought to compare the outcome of PVI in dialysis patients with those with normal kidney function. Methods Using weighted data from the National Inpatient Sample database between 2002 and 2014, we identified all peripheral artery disease (PAD) patients aged ≥18 years that underwent PVI. Multivariate logistic regression analysis was performed to examine in‐hospital outcomes. Results Of 1,186,192 patients who underwent PVI, 1,066,830 had normal kidney function (89.9%) and 119,362 had ESRD requiring dialysis (10.1%). Critical limb ischemia was more prevalent in dialysis patients (63.2 vs. 34.0%, p < .001). Compared with normal kidney function group, ESRD requiring dialysis was associated with higher in‐hospital mortality (1.5 vs. 4.2%, adjusted OR: 2.13 [95% CI: 2.04–2.23]) and longer length of hospital stay (median 3 days, Interquartile range [IQR] (0–6) vs. 7 days, IQR (4–18); p < .001). Dialysis patients had higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke; 14.3 vs. 9.8%, p < .001) and net adverse cardiovascular events (composite of MACE, major bleeding, or vascular complications; 40.8 vs. 29.1%, p < .001). ESRD patients less frequently underwent open bypass (5.6 vs. 8.5%, p < .001) and more frequently had major amputation (10.3 vs. 3.0%, p < .001) compared with normal kidney function group. Conclusion PAD patients on dialysis who underwent PVI have higher rates of mortality and adverse outcomes as compared to those with normal kidney function.

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Alprostadil treatment of critical limb ischemia in hemodialysis patients

Popp

Knoll

Sprenger-Mähr

et al. 2018

Wien Klin Wochenschr

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Summary Background Peripheral artery disease and critical limb ischemia are common in patients undergoing chronic hemodialysis treatment and are associated with a high rate of amputation and mortality. The effect of treatment with prostanoids in this specific group of patients is unknown. Methods A retrospective single-center analysis of hemodialysis patients with critical limb ischemia was performed who were treated with the prostanoid analogue alprostadil as an infusion during hemodialysis in the period from 2000 to 2013. The primary study outcome was a combined end-point including amputation and death 1 year after start of alprostadil. Kaplan-Meier curves were used to describe amputation-free survival and overall survival. A multivariable adjusted Cox proportional hazards model was calculated for the primary outcome. Results A total of 86 patients (60 males, 69.7%) were studied. The median alprostadil treatment period was 1.8 months. The 1-year amputation-free survival was 41%. In 36% of patients an amputation was necessary and 35% died. Despite alprostadil treatment, 36% of the study patients additionally underwent an endovascular procedure and 16% had bypass surgery. Men had a significantly higher amputation rate (45%) than women (15%) (P= 0.009). Male sex and dialysis vintage were significantly associated with an increased risk for primary outcome Conclusions Despite treatment with alprostadil the mortality, amputation rate and the need for revascularization procedures in hemodialysis patients with critical limb ischemia remained high. The outcome, however, was comparable with that of other treatment, such as endovascular procedures and bypass surgery. The effect of any current treatment strategy on amputation rate or mortality in that patient group remains uncertain.

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Relation of Baseline Renal Dysfunction With Outcomes in Patients Undergoing Popliteal and Infrapopliteal Percutaneous Peripheral Arterial Interventions

Cited by 7 publications

References 17 publications

Chronic kidney disease exacerbates ischemic limb myopathy in mice via altered mitochondrial energetics

Chronic kidney disease exacerbates ischemic limb myopathy in mice via altered mitochondrial energetics

In‐hospital outcome of peripheral vascular intervention in dialysis‐dependent end‐stage renal disease patients

Alprostadil treatment of critical limb ischemia in hemodialysis patients

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