title: Rates of future hemodialysis risk and beneficial outcomes for patients with chronic kidney disease undergoing recanalization of chronic total occlusion.
abstract: BACKGROUND
  This study aimed to assess the prognosis and deleterious effects of chronic kidney disease (CKD) on future renal function, in patients who had undergone chronic total occlusion-percutaneous coronary intervention (CTO-PCI).
  
  
  METHODS
  The treatment effects were studied in 739 patients who underwent CTO-PCI. The patients were divided into 3 groups according to estimated glomerular filtration rate (eGFR): non-CKD (eGFR≥60ml/min/1.73m(2), n=562), CKD-1 (45≤eGFR<60ml/min/1.73m(2), n=90), and CKD-2 (eGFR<45ml/min/1.73m(2), n=87). Future hemodialysis (HD) rates and the prevalence of acute kidney injury (AKI) except for 45 patients undergoing regular HD, and other clinical and prognostic outcomes were compared between the 3 groups.
  
  
  RESULTS
  Procedural success rates showed trends toward lower prevalence across the 3 groups (89.5%, 84.4%, and 81.6%, p=0.060). The prevalence of AKI significantly differed between the 3 groups (4.6%, 8.9%, and 16.7%, p=0.001), whereas no patients were introduced to regular HD at discharge. During a median follow-up period of 51.2±28.9months, newly required HD significantly differed between the 3 groups (0.7%, 0%, and 7.1%, p<0.001). When compared with unsuccessful CTO-PCI, successful CTO-PCI was found to improve cardiovascular mortality in the non-CKD and CKD-1 (Log-rank test: p=0.025, p=0.024, respectively) and to improve both cardiovascular and all-cause mortality in the CKD-2 (Log-rank test: p=0.027, p=0.0022, respectively).
  
  
  CONCLUSIONS
  Although CTO-PCI for patients with advanced CKD was associated with a high risk of future HD introduction, not directly owing to CTO-PCI and AKI, successful treatment of CTO might contribute to better survival benefit regardless of the presence or absence of CKD.
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
authors: Tetsuro
authors: T
authors: Shimura
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan. Electronic address: yamamoto@heart-center.or.jp.
authors: Masanori
authors: M
authors: Yamamoto
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan. Electronic address: tsuchikane@heart-center.or.jp.
authors: Etsuo
authors: E
authors: Tsuchikane
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
authors: Tomohiko
authors: T
authors: Teramoto
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
authors: Masashi
authors: M
authors: Kimura
authors: Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.
authors: Hitoshi
authors: H
authors: Matsuo
authors: Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.
authors: Yoshiaki
authors: Y
authors: Kawase
authors: Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Aichi, Japan.
authors: Yoriyasu
authors: Y
authors: Suzuki
authors: Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Aichi, Japan.
authors: Seiji
authors: S
authors: Kano
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
authors: Maoto
authors: M
authors: Habara
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
authors: Kenya
authors: K
authors: Nasu
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
authors: Yoshihisa
authors: Y
authors: Kinoshita
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
authors: Mitsuyasu
authors: M
authors: Terashima
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
authors: Tetsuo
authors: T
authors: Matsubara
authors: Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
authors: Takahiko
authors: T
authors: Suzuki
mesh_terms: D000368:Aged; D054059:Coronary Occlusion / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Chronic kidney disease; Chronic total occlusion; Coronary artery disease; Hemodialysis; Percutaneous coronary intervention