title: The role of chronic kidney disease as a predictor of outcome after revascularisation of the ulcerated diabetic foot.
abstract: OBJECTIVE
  The aim of the study was to stratify the risk of diabetic patients with leg ulcer or gangrene undergoing infrainguinal revascularisation for critical limb ischaemia.
  
  
  METHODS
  The study cohort included 732 revascularisation procedures performed in 597 diabetic patients with ulcer or gangrene. Logistic regression and CART analysis were used for identification of predictors of 1-year outcome.
  
  
  RESULTS
  Logistic regression showed that chronic kidney disease (CKD) class (OR 1.38, 95% CI 1.16, 1.65) was an independent predictor of 1-year leg salvage (area under the receiver operating characteristic [ROC] curve 0.60, 95% CI 0.54, 0.65). The terminal nodes of the CART for 1-year leg salvage were CKD classes 4-5, the level (infrapopliteal vs femoropopliteal revascularisation), type of revascularisation (bypass surgery vs percutaneous transluminal angioplasty) and gangrene (area under the ROC curve 0.62, 95% CI 0.57, 0.68). Logistic regression showed that pulmonary disease (OR 1.76, 95% CI 1.11, 2.78), CKD class (OR 1.43, 95% CI 1.24, 1.65), foot gangrene (OR 1.76, 95% CI 1.21, 2.60) and patient age (OR 1.02, 95% CI 1.01, 1.04) were independent predictors of 1-year amputation-free survival (area under the ROC curve 0.65, 95% CI 0.60, 0.69). The terminal nodes of the CART for 1-year amputation-free survival were CKD classes 3-5, patient's age of ≥ 75 years and foot gangrene (area under the ROC curve 0.64, 95% CI 0.60, 0.68).
  
  
  CONCLUSIONS
  CKD is a formidable risk factor for poor intermediate outcome after infrainguinal revascularisation in diabetic patients with foot ulcer or gangrene. CART analysis indicates that foot gangrene is also a significant risk factor for adverse outcome.
authors.affiliation: Department of Vascular Surgery, Helsinki University Central Hospital, PO Box 340, 00029 HUS Helsinki, Finland. maarit.venermo@hus.fi
authors.forename: M
authors.initials: M
authors.lastname: Venermo
authors.forename: F
authors.initials: F
authors.lastname: Biancari
authors.forename: E
authors.initials: E
authors.lastname: Arvela
authors.forename: M
authors.initials: M
authors.lastname: Korhonen
authors.forename: M
authors.initials: M
authors.lastname: Söderström
authors.forename: K
authors.initials: K
authors.lastname: Halmesmäki
authors.forename: A
authors.initials: A
authors.lastname: Albäck
authors.forename: M
authors.initials: M
authors.lastname: Lepäntalo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D005528:Foot / Q000098:blood supply* / Q000601:surgery; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications*; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods