title: Peripheral Vascular Disease and Death in Southern European Kidney Transplant Candidates: A Competing Risk Modeling Approach.
abstract: The association between peripheral vascular disease (PVD) and survival among kidney transplant (KT) candidates is uncertain.
  
  
  
  We assessed 3851 adult KT candidates from the Andalusian Registry between 1984 and 2012. Whereas 1975 patients received a KT and were censored, 1876 were on the waiting list at any time. Overall median waitlist time was 21.2 months (interquartile range, 11-37.4). We assessed the association between PVD and mortality in waitlisted patients using a multivariate Cox regression model, with a competing risk approach as a sensitivity analysis.
  
  
  
  Peripheral vascular disease existed in 308 KT candidates at waitlist entry. The prevalence of PVD among nondiabetic and diabetic patients was 4.5% and 25.3% (P < 0.0001). All-cause mortality was higher in candidates with PVD (45% vs 21%; P < 0.0001). Among patients on the waiting list (n = 1876) who died (n = 446; 24%), 272 (61%) died within 2 years after listing. Cumulative incidence of all-cause mortality at 2 years in patients with and without PVD was 23% and 6.4%, respectively (P < 0.0001); similar differences were observed in patients with and without diabetes. By competing risk models, PVD was associated with a 1.9-fold increased risk of mortality (95% confidence interval [95% CI], 1.4-2.5). This association was stronger in waitlisted patients without cardiac disease (subhazard ratio, 2.2; 95% CI, 1.6-3.1) versus those with cardiac disorders (subhazard ratio, 1.5; 95% CI, 0.9-2.5). No other significant interactions were observed. Similar results were seen after excluding diabetics.
  
  
  
  Peripheral vascular disease is a strong predictor of mortality in KT candidates. Identification of PVD at list entry may contribute to optimize targeted therapeutic interventions and help prioritize high-risk KT candidates.
authors.affiliation: 1 Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, Málaga, Spain. 2 Transplant Coordinator Center and Andalusian Health Service, Seville, Spain. 3 Clinic Biostatistic Unit, Hospital Ramón y Cajal IRYCIS, CIBERESP, Madrid, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Hernández
authors.forename: Pablo
authors.initials: P
authors.lastname: Castro de la Nuez
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.forename: Pedro
authors.initials: P
authors.lastname: Ruiz-Esteban
authors.forename: Edisson
authors.initials: E
authors.lastname: Rudas
authors.forename: Miguel
authors.initials: M
authors.lastname: González-Molina
authors.forename: Dolores
authors.initials: D
authors.lastname: Burgos
authors.forename: Mercedes
authors.initials: M
authors.lastname: Cabello
authors.forename: Eulalia
authors.initials: E
authors.lastname: Palma
authors.forename: Elena
authors.initials: E
authors.lastname: Gutiérrez
authors.forename: Manuel
authors.initials: M
authors.lastname: Alonso
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000401:mortality*; D015995:Prevalence; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014850:Waiting Lists / Q000401:mortality*