title: Wound healing of critical limb ischemia with tissue loss in patients on hemodialysis.
abstract: We assessed wound healing in patients on hemodialysis (HD) with critical limb ischemia (CLI). This study enrolled 267 patients (including 120 patients on HD and 147 patients not on HD) who underwent endovascular therapy (EVT) for CLI. The primary endpoint was wound-healing rate at two years. Secondary endpoints were time to wound healing, wound recurrence rate, and limb salvage at two years. The percentage of male and young patients was higher in the HD patients ( p < 0.01). A lower patency of the pedal arch after EVT was observed frequently in HD patients ( p < 0.01). The wound-healing rate was significantly lower in HD patients (79.5% vs. 92.4%, p < 0.001). Time to wound healing was significantly longer in HD patients (median 132 days vs. 82 days, p = 0.005). Wound recurrence was observed more frequently in HD patients (25.0% vs. 10.2%, p = 0.007). Limb salvage (72.8% vs. 86.4%, p = 0.002) was significantly lower in HD patients. In a cox proportional hazard model, HD was an independent predictor of wound healing (risk ratio (RR), 0.46; 95% confidence interval (CI), 0.33-0.62; p < 0.001) and wound recurrence (RR, 1.58; 95% CI, 1.11-2.22; p = 0.01). HD was independently associated with lower and delayed wound healing, and wound recurrence.
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Honda
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamawaki
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Mori
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Shigemitsu
authors.initials: S
authors.lastname: Shirai
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Makino
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tokuda
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Takama
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Tsutumi
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takimura
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D016009:Chi-Square Distribution; D016638:Critical Illness; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D007564:Japan; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Critical limb ischemia; endovascular therapy; hemodialysis; wound healing