title: Relation of Baseline Renal Dysfunction With Outcomes in Patients Undergoing Popliteal and Infrapopliteal Percutaneous Peripheral Arterial Interventions.
abstract: Renal dysfunction is a major risk factor for peripheral arterial disease (PAD). Infrapopliteal PAD is associated with more co-morbid conditions and worse prognosis than suprapopliteal PAD. Long-term outcomes of patients with renal dysfunction and popliteal or infrapopliteal PAD undergoing peripheral vascular intervention (PVI) are not well described. We retrospectively evaluated long-term outcomes in 726 patients undergoing infrapopliteal PVI categorized into 3 glomerular filtration rate (GFR)-based groups: GFR (≥60 ml/min/1.73 m(2)), GFR (<60 ml/min/1.73 m(2)), and those on dialysis. At mean follow-up of 36 ± 20 months, amputation rates were 3%, 5%, and 11% with mortality rates of 23%, 36%, and 56% in normal renal function, chronic kidney disease (adjusted odds ratio [OR] for amputation 1.75, 95% CI 0.73 to 4.21; adjusted OR for mortality 1.53, 95% CI 1.05 to 2.23, p = 0.028), and dialysis (adjusted OR for amputation 2.43, 95% CI 0.84 to 7.02, p = 0.100; adjusted OR for mortality 4.51, 95% CI 2.46 to 8.26, p <0.0001) groups, respectively. Repeat revascularization was similar in all 3 groups at roughly 25%. In conclusion, chronic kidney disease and dialysis were associated with increased major amputations and mortality in patients who received PVI for popliteal and infrapopliteal PAD.
authors.affiliation: Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan. Electronic address: kesav.parvataneni@stjohn.org.
authors.forename: Kesav C
authors.initials: KC
authors.lastname: Parvataneni
authors.affiliation: Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Chatchawan
authors.initials: C
authors.lastname: Piyaskulkaew
authors.affiliation: Department of Medical Education, St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Susan
authors.initials: S
authors.lastname: Szpunar
authors.affiliation: Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Tarun
authors.initials: T
authors.lastname: Sharma
authors.affiliation: Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Vishal
authors.initials: V
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Saurabhkumar
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Thomas
authors.initials: T
authors.lastname: Davis
authors.affiliation: Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lalonde
authors.affiliation: Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamasaki
authors.affiliation: Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Rosman
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D000800:Angioplasty, Balloon; D017222:Angioplasty, Balloon, Laser-Assisted; D015897:Comorbidity; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome