The prevalence and prognostic implications of polyvascular atherosclerotic disease in patients with chronic kidney disease.
BACKGROUND
Atherosclerotic disease is often extended to multiple affected vascular beds (AVB). Polyvascular disease (PVD) and chronic kidney disease (CKD) have both separately been associated with an adverse cardiovascular outcome. We assessed the prevalence of PVD in vascular surgery patients with preoperative CKD and studied the influence on long-term cardiovascular survival.


METHODS
Consecutive patients (2933) were preoperatively screened for PVD, defined as 1-, 2- or 3-AVB. Preoperative glomerular filtration rate (GFR in ml/min/1.73 m(2) body-surface area) was estimated by the Modification of Diet in Renal Disease (MDRD) prediction equation, and patients were categorized according their estimated GFR. Primary end point was (cardiovascular) mortality during a median follow-up of 6.0 years (IQR 2-9).


RESULTS
Preoperative MDRD-GFR was classified as normal kidney function (GFR >or= 90) or mild (GFR 60-89), moderate (GFR 30-59) and severe (GFR < 30) kidney disease in 779 (27%), 1423 (48%), 605 (21%) and 124 (4%) patients, respectively. One-vessel disease was present in 54% of the patients with normal kidney function, while 62% of the patients with CKD (GFR < 60) had PVD. In patients with moderate or severe kidney disease, the presence of PVD was independently associated with even higher cardiovascular mortality rates (2-AVB: HR 1.65 95%CI 1.09-2.48; 3-AVB: 2.07 95%CI 1.08-3.99), compared to 1-AVB.


CONCLUSIONS
Patients with CKD had a high prevalence of PVD, which was independently associated with increased all-cause and cardiovascular mortality.
van Kuijk
Jan-Peter
JP
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Flu
Willem-Jan
WJ
Chonchol
Michel
M
Welten
Gijs M J M
GM
Verhagen
Hence J M
HJ
Bax
Jeroen J
JJ
Poldermans
Don
D
D000368:Aged; D050197:Atherosclerosis / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors