title: Impact of chronic kidney disease in patients undergoing percutaneous or surgical carotid artery revascularization: Insights of the healthcare cost and utilization Project's National Inpatient Sample.
abstract: OBJECTIVE
  Carotid artery stenting (CAS) and carotid artery endarterectomy (CEA) are complementary techniques for management of patients with carotid artery stenosis. This study investigates the impact of chronic kidney disease (CKD) and age on outcomes after carotid artery revascularization.
  
  
  METHODS
  National Inpatient Sample was surveyed for CAS and CEA among stage 3 and 4 CKD and stage 5/end stage renal disease (ESRD) patients from 2004 to 2012. Primary endpoint was in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) stratified by kidney function and age. Regression analysis and propensity score matching were utilized.
  
  
  RESULTS
  There were 3299 patients that underwent CEA and 652 underwent CAS with stage 3 and 4 CKD. Whereas, 1630 patients underwent CEA and 511 patients underwent CAS with stage 5 CKD/ESRD. Patients undergoing CAS had more in-hospital MACCE. Coronary artery disease (OR1.35, 95%CI:1.07-1.70) and CAS (OR1.35, 95%CI:1.02-1.77) were independently associated with MACCE for stage 3 and 4 CKD patients. For the stage 5 CKD/ESRD cohort, CAS (OR1.75, 95%CI:1.29-2.37) was independently associated with MACCE. Stratifying by age, showed no difference in event rates except for higher MACCE among patients <60years old with stage 5 CKD/ESRD undergoing CAS (p<0.001). Propensity score matching showed that treatment type had no significant effect on MACCE rates.
  
  
  CONCLUSIONS
  Among CKD cohorts studied nationally, in-hospital MACCE were higher for patients that underwent CAS. Overall, age group analyses showed that there was no difference in MACCE rates between CAS and CEA. Although CAS was independently associated with MACCE, propensity score matching showed no risk difference of MACCE between CAS and CEA for either CKD cohort.
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, Stony Brook University Medical Center, Stony Brook, NY.
authors.forename: Fabio V
authors.initials: FV
authors.lastname: Lima
authors.affiliation: Graduate Program in Public Health, Stony Brook University Medical Center, Stony Brook, NY.
authors.forename: Tzyy Yun M
authors.initials: TY
authors.lastname: Yen
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, Stony Brook University Medical Center, Stony Brook, NY.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY.
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY.
authors.forename: Jianjin
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, Stony Brook University Medical Center, Stony Brook, NY. Electronic address: luis.gruberg@stonybrook.edu.
authors.forename: Luis
authors.initials: L
authors.lastname: Gruberg
mesh_terms: D000367:Age Factors; D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy*; D002561:Cerebrovascular Disorders / Q000209:etiology; D016009:Chi-Square Distribution; D016208:Databases, Factual; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000191:economics*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006331:Heart Diseases / Q000209:etiology; D017721:Hospital Costs; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017064:Process Assessment, Health Care / Q000191:economics*; D057216:Propensity Score; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000191:economics*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Carotid artery endarterectomy; Carotid artery stenting; Chronic kidney disease