title: Loss of kidney function in patients with critical limb ischemia treated endovascularly or surgically.
abstract: BACKGROUND
  Acute kidney injury after the administration of contrast material during endovascular procedures for peripheral arterial disease generally recovers with supportive treatment. However, long-term effects of endovascular procedures for critical limb ischemia on renal function remain to be investigated.
  
  
  METHODS
  This retrospective observational cohort study included all patients who newly presented to the vascular surgery outpatient clinic with Rutherford class 4 to class 6 peripheral arterial disease and who were treated with either endovascular or surgical interventions. Changes in estimated glomerular filtration rate (eGFR) after 1 year were compared between the two types of intervention. Multivariate linear regression analysis was done to correct for potential confounders.
  
  
  RESULTS
  One year after treatment, eGFR was reduced by 15.0 mL/min (95% confidence interval [CI], 13.1-17.0; P < .001) after endovascular interventions (n = 209) and by 7.6 mL/min (95% CI, 5.1-10.0; P < .001) after surgical therapy (n = 81). Although eGFR rates decreased in both groups, loss of renal function was significantly greater in patients after endovascular interventions (P < .001). Furthermore, 77% of patients receiving endovascular interventions experienced fast renal decline (defined as >4 mL/min loss of eGFR within 1 year) compared with 54% of patients treated surgically (P < .001). After correction for potential confounders, endovascular intervention was associated with 7.4 mL/min (95% CI, 5.4-9.3; P < .001) greater loss of renal function compared with patients treated surgically.
  
  
  CONCLUSIONS
  Endovascular procedures for critical limb ischemia are associated with clinically relevant permanent long-term loss of kidney function. This loss of renal function is greater than in comparable patients who were treated with open surgery.
authors.affiliation: Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands. Electronic address: timsigterman@gmail.com.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Sigterman
authors.affiliation: Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
authors.forename: Lars J J
authors.initials: LJ
authors.lastname: Bolt
authors.affiliation: Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
authors.forename: Attila G
authors.initials: AG
authors.lastname: Krasznai
authors.affiliation: Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Snoeijs
authors.affiliation: Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: Heijboer
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Geert-Willem H
authors.initials: GH
authors.lastname: Schurink
authors.affiliation: Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Bouwman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D018450:Disease Progression; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality