Systematic review and meta-analysis of outcomes of lower extremity peripheral arterial interventions in patients with and without chronic kidney disease or end-stage renal disease

Narayanan, Mahesh Anantha; Sheikh, Azfar Bilal; Nagpal, Sameer; Jelani, Qurat‐ul‐ain; Smolderen, Kim G.; Regan, Christopher; Ionescu, Cătălina; Chaar, Cassius Iyad Ochoa; Schneider, Marcie; Llanos-Chea, Fiorella; Mena‐Hurtado, Carlos

doi:10.1016/j.jvs.2020.08.032

Cited by 23 publications

(17 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Except for a few observational studies, there has been a paucity of data on the impact of both CKD and ESKD on outcomes after revascularisation of symptomatic PAOD [ 5 , 7 , 11 , 17 , 18 , 21 ]. While several previous studies used administrative registries and reimbursement codes with large numbers to determine the complex interactions of kidney disease with cardiovascular disease, there is evidence that billing codes are not a completely accurate way to identify advanced kidney disease stages [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with ESKD were previously considered a high risk-group by clinical guidelines while these patients were often excluded from trials and studies [ 7 , 33 ]. Even if patients with CKD were included, studies often fall short in considering additional risk factors that are associated with CKD such as diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the impact of diabetes on the development and long-term course of cardiovascular disease significantly expands the burden of this growing target population. Chronic kidney disease (CKD) counts as an important risk factor for cardiovascular disease and vice versa [ 4 , 5 , 6 , 7 , 8 , 9 ]. Several studies have shown that CKD was frequent amongst patients with PAOD, and that kidney disease was further associated with worse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…To date, the available evidence is mainly based on retrospective observational studies and there is a paucity of mid-term outcomes [ 5 , 7 , 11 , 17 , 18 ]. Thus, evidence-based recommendations to guide the therapy of patients with CKD are still lacking while valid practice guidelines also do not contain strong recommendations concerning screening strategies in cohorts at risk [ 4 , 7 , 10 , 19 , 20 , 21 , 22 ]. These gaps in knowledge and the need for further studies on the combination of PAOD and CKD was highlighted just recently in a conference conclusion of the Kidney Disease: Improving Global Outcomes (KDIGO).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

The Impact of Chronic Kidney Disease on Mid-Term Outcomes after Revascularisation of Peripheral Arterial Occlusive Disease: Results from a Prospective Cohort Study

Kotov

Blasche

Peters

et al. 2022

JCM

View full text Add to dashboard Cite

Objective: The current study aimed to determine the relationship between chronic kidney disease (CKD) and major 12-month outcomes for patients with in-hospital treatment for symptomatic peripheral arterial occlusive disease (PAOD). Methods: An analysis of the prospective longitudinal multicentric cohort study with 12-month follow-up was conducted including patients who underwent endovascular or open surgery for symptomatic PAOD at 35 German vascular centres (initial study protocol: NCT03098290). Severity of CKD was grouped into four stages combining information about the estimated glomerular filtration rate (eGFR) at baseline and dialysis dependency. Outcomes included overall mortality as well as the two composite endpoints of amputation or death, and of major cardiovascular events (MACE). 12-month incidences and adjusted hazard ratios were estimated using the Kaplan–Meier function and Cox proportional hazard models. Results: A total of 4354 patients (32% female, 69 years mean age, 68% intermittent claudication, 69% percutaneous endovascular revascularisation) were included and followed for 244 days in median. Thereof, 22% had any CKD and 5% had end stage kidney disease (ESKD) at baseline. The 12-month overall mortality rate was 3.6% (95% CI 2.3–4.9) with 96 events in the entire cohort: 147 were amputated or died (5.3%, 95% CI 5.2–5.3), and 277 had a MACE (9.5%, 95% CI 9.4–9.5). When compared with patients without kidney disease, ESKD was significantly associated with overall mortality (HR 1.9; 95% CI 1.1–3.5), amputation or death (HR 2.4; 95% CI 1.4–4.1), and MACE (HR 2.0; 95% CI 1.3–3.2). Conclusions: In the current study on mid-term outcomes after invasive revascularisation for symptomatic PAOD, one out of five patients suffered from any CKD while those few with ESKD had twice the odds of death, of amputation or death, and of major adverse cardiovascular events after twelve months. These results emphasise that concomitant CKD and its impact on outcomes should be considered by severity while mild and moderate grades should not lead to ineffectual treatment strategies.

show abstract