Renal dysfunction predicts long-term mortality in patients with lower extremity arterial disease.
BACKGROUND
Patients with renal insufficiency tend to suffer from advanced atherosclerosis and exhibit a reduced life expectancy.


OBJECTIVE
This prospective study investigated the relation between renal dysfunction and long-term all-cause and cardiovascular mortality in a population of nonsurgical patients with lower extremity arterial disease (LEAD).


METHODS
A total of 357 patients with symptomatic LEAD underwent baseline glomerular filtration rate (GFR) estimation by the 4-variable Modification Diet in Renal Diseases equation, and were then followed for 4.2 years (range: 1-17).


RESULTS
During follow-up, 131 patients died (8.6 deaths per 100 patient-years), 79 of whom (60%) from cardiovascular causes. All-cause death rates were 3.8, 6.6, and 15.5 per 100 patient-years, respectively, in the groups with normal GFR, mild reduction in GFR (60-89 mL min(-1) per 1.73 m2) and chronic kidney disease (CKD; <60 mL min(-1) per 1.73 m2; P < 0.001 by log-rank test). Compared to patients with normal renal function, the risk of all-cause and cardiovascular death was significantly higher in patients with CKD [hazard ratio, respectively, 2.23, 95% confidence interval (CI): 1.16-4.34, P = 0.017; 2.15, 95% CI: 1.05-4.43, P = 0.03]. The association of CKD with all-cause and cardiovascular mortality were independent of age, LEAD severity, cardiovascular risk factors and treatment with angiotensin-converting enzyme (ACE)-inhibitors, hypolipidaemic and antiplatelet drugs. The power of GFR in predicting all-cause death was higher than that of ankle-brachial pressure index (P = 0.029) and Framingham risk score (P < 0.0001).


CONCLUSIONS
Chronic kidney disease strongly predicts long-term mortality in patients with symptomatic LEAD irrespective of disease severity, cardiovascular risk factors and concomitant treatments.
Pasqualini
L
L
Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. lpasqua@unipg.it
Schillaci
G
G
Pirro
M
M
Vaudo
G
G
Siepi
D
D
Innocente
S
S
Ciuffetti
G
G
Mannarino
E
E
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007668:Kidney / Q000503:physiopathology; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D051437:Renal Insufficiency / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment / Q000379:methods; D012907:Smoking / Q000009:adverse effects; D015996:Survival Rate
D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003404:Creatinine