title: Effect of Chronic Kidney Disease on Mortality in Patients Who Underwent Lower Extremity Peripheral Vascular Intervention.
abstract: It is known that chronic kidney disease (CKD) is associated with increased postoperative morbidity and mortality in patients with peripheral artery disease who underwent lower extremity surgical revascularization; however, outcomes after peripheral vascular intervention (PVI) are less well established. This study sought to determine the impact of CKD on adverse outcomes in patients with peripheral artery disease who underwent PVI. Using data from the Veteran Affairs Clinical Assessment, Reporting, and Tracking System Program, we identified a cohort of 755 patients who underwent lower extremity PVI from June 2005 to August 2010 at 33 sites. The outcomes of interest were mortality, progression to dialysis, myocardial infarction, limb amputation, and stroke. Kaplan-Meier survival analysis and Cox proportional hazard frailty models assessed the association between CKD and adverse outcomes. Of the patients who underwent lower extremity PVI, 201 patients (27%) had CKD. The presence of CKD was associated with decreased survival (5-year survival probability of CKD compared with non-CKD: 49.9% [41.6% to 59.9%] vs 80.1% [76.2% to 84.1]), which persisted after risk adjustment (HR 1.57; 95% confidence interval 1.13 to 2.19). In addition, there was a significant association between CKD and progression to dialysis (HR 6.62; 95% confidence interval 2.25 to 19.43). In contrast, there was no association between CKD and re-hospitalization for myocardial infarction, limb amputation, or stroke. In conclusion, CKD is present in 1 of 4 patients who underwent PVI and is associated with increased risk of mortality and progression to dialysis.
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Joe X
authors.initials: JX
authors.lastname: Xie
authors.affiliation: Division of Cardiology, VA Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Glorioso
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Dattilo
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Vikas
authors.initials: V
authors.lastname: Aggarwal
authors.affiliation: Division of Cardiology, VA Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: Division of Cardiology, VA Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Barón
authors.affiliation: Division of Cardiology, VA Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Darcy
authors.initials: D
authors.lastname: Donaldson
authors.affiliation: Division of Cardiology, VA Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.affiliation: Division of Cardiology, St. Louis University School of Medicine, St. Louis, Missouri.
authors.forename: Andrew
authors.initials: A
authors.lastname: Klein
authors.affiliation: Division of Cardiology, Philadelphia VA Medical Center, Philadelphia, Pennsylvania.
authors.forename: Jay
authors.initials: J
authors.lastname: Giri
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; Division of Cardiology, VA Eastern Colorado Health Care System, Denver, Colorado; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado. Electronic address: thomas.tsai@coloradooutcomes.org.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D016491:Peripheral Vascular Diseases / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D014656:Vascular Surgical Procedures