Clinical Outcomes after Endovascular Therapy Among Hemodialysis Patients with Peripheral Artery Disease Stratified by the Primary Kidney Disease.

Abstract

OBJECTIVES:

The objective of this study was to investigate the clinical characteristics of hemodialysis patients with peripheral artery disease (PAD) and the outcomes after endovascular therapy (EVT) in such patients stratified by the primary kidney disease.

METHODS:

This retrospective observational study evaluated 142 consecutive hemodialysis patients with symptomatic PAD who underwent EVT (men: n = 103, age: 74 ± 8 years). Patients were divided into 3 groups in accordance with the reason for hemodialysis: hypertensive nephrosclerosis (HTN [n = 26]), diabetic nephropathy (DN [n = 85]), and chronic glomerulosclerosis (CGN [n = 31]). The primary outcome was major adverse event(s) (MAEs), including target lesion revascularization, major amputation, and all-cause death. Clinical characteristics and outcomes were compared among the 3 groups.

RESULTS:

Patients with HTN were older (81 ± 6 years vs. 72 ± 8 years vs. 74 ± 8 years; P < 0.001) and had a shorter hemodialysis vintage (2.4 years vs. 6.8 years vs. 11.2 years; P < 0.001) than those with DN and CGN. Critical limb ischemia (CLI) affected 15 (58%) patients in the HTN group, 52 (61%) in the DN group, and 10 (32%) in the CGN group. Target lesion length was longer in patients with HTN than in those in the other groups (155 ± 101 mm vs. 108 ± 77 mm [DN] vs. 98 ± 76 mm [CGN]; P = 0.020). During a median follow-up period of 372 days (interquartile range, 198-730 days), Kaplan-Meier curve analysis revealed that HTN was associated with an increased risk for MAEs (χ2 11.6; P = 0.003). Furthermore, multivariate Cox regression analysis revealed that CLI, HTN, and B-type natriuretic peptide levels were independent predictors of MAE (hazard ratio 3.91, 2.88, and 1.00; P < 0.001, P < 0.001, and P = 0.001, respectively).

CONCLUSIONS:

Among hemodialysis patients with PAD, HTN was associated with an increased risk for MAEs after EVT.

• Authors: Munehiro Iiya, Hiroyuki Hikita, Hiroshi Yoshikawa, Fumiyuki Abe, Shihoko Tsujihata, Naruhiko Ito, Yoshinori Kanno, Keiichi Hishikari, Tadashi Murai, Atsushi Takahashi, Tetsuo Sasano
• Journal: Annals of vascular surgery (Ann Vasc Surg) Vol. 73 Pg. 197-204 (May 2021) ISSN: 1615-5947 [Electronic] Netherlands
• PMID: 33418070 (Publication Type: Comparative Study, Journal Article, Observational Study)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Diabetic Nephropathies (etiology, therapy)
• Endovascular Procedures (adverse effects, mortality)
• Female
• Glomerulonephritis (etiology, therapy)
• Humans
• Hypertension (complications)
• Kidney Diseases (diagnosis, etiology, mortality, therapy)
• Male
• Nephrosclerosis (etiology, therapy)
• Peripheral Arterial Disease (complications, diagnosis, mortality, therapy)
• Renal Dialysis (adverse effects, mortality)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome