title: The Impact of Chronic Kidney Disease on Hospitalized Patients With Peripheral Arterial Disease and Critical Limb Ischemia.
abstract: Peripheral arterial disease (PAD) and chronic kidney disease (CKD) are major public health problems worldwide. Evaluations of large-scale data on morbidity, outcome, and costs in patients having PAD with CKD are essential. Cross-sectional nationwide population-based analysis of all hospitalizations for PAD during 2009 in Germany focused on the stage-related impact of CKD on morbidity, in-hospital mortality, amputations, length of hospital stay, and health-related expenditure. The total number of hospitalizations was 483 961. Of those, 132 993 (27.5%) had CKD. Chronic kidney disease caused 1.8-fold higher amputation rate ( P < .001) with a stepwise increasing rate with higher CKD stage. Chronic kidney disease doubled in-hospital mortality of patients with PAD (7.8%; n = 10 421) versus 4.0% (n = 14 174, P < .001) with a stepwise increasing risk with higher CKD stage ( P < .001). The highest in-hospital mortality occurred in patients with coprevalence of CKD stage 4 and Fontaine stage IV (16.4%, n = 1176, P < .001). Chronic kidney disease caused 15% higher costs and 21% increased length of stay compared to the whole PAD cohort. This analysis demonstrates the stage-related influence of CKD on morbidity, in-hospital mortality, amputations, length of hospital stay, and reimbursement costs of hospitalized patients with PAD.
authors.affiliation: 1 Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Lüders
authors.affiliation: 2 Institute for Health and Social research (IGES) Berlin, Berlin, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Fürstenberg
authors.affiliation: 1 Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Engelbertz
authors.affiliation: 1 Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Gebauer
authors.affiliation: 1 Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Meyborg
authors.affiliation: 1 Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Nasser M
authors.initials: NM
authors.lastname: Malyar
authors.affiliation: 1 Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D005102:Health Expenditures; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007511:Ischemia / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology / Q000601:surgery
keywords: amputations; chronic kidney disease; economic impact; in-hospital mortality; length of hospital stays; peripheral arterial disease