Effect of Chronic Kidney Disease on Mortality in Patients Who Underwent Lower Extremity Peripheral Vascular Intervention

Joe X. Xie, Thomas J. Glorioso, Philip B. Dattilo, Vikas Aggarwal, P. Michael Ho, Anna E. Barón, Darcy Donaldson, Ehrin J. Armstrong, Andrew Klein, Jay Giri, Thomas T. Tsai

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)669-674
Number of pages6
JournalAmerican Journal of Cardiology
Volume119
Issue number4
DOIs
StatePublished - Feb 15 2017
Externally publishedYes

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Chronic Renal Insufficiency
Blood Vessels
Lower Extremity
Mortality
Dialysis
Peripheral Arterial Disease
Amputation
Extremities
Stroke
Myocardial Infarction
Confidence Intervals
Risk Adjustment
Survival
Kaplan-Meier Estimate
Kidney Diseases
Veterans
Survival Analysis
Proportional Hazards Models
Disease Progression
Hospitalization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Xie, J. X., Glorioso, T. J., Dattilo, P. B., Aggarwal, V., Ho, P. M., Barón, A. E., ... Tsai, T. T. (2017). Effect of Chronic Kidney Disease on Mortality in Patients Who Underwent Lower Extremity Peripheral Vascular Intervention. American Journal of Cardiology, 119(4), 669-674. https://doi.org/10.1016/j.amjcard.2016.10.053

Effect of Chronic Kidney Disease on Mortality in Patients Who Underwent Lower Extremity Peripheral Vascular Intervention. / Xie, Joe X.; Glorioso, Thomas J.; Dattilo, Philip B.; Aggarwal, Vikas; Ho, P. Michael; Barón, Anna E.; Donaldson, Darcy; Armstrong, Ehrin J.; Klein, Andrew; Giri, Jay; Tsai, Thomas T.

In: American Journal of Cardiology, Vol. 119, No. 4, 15.02.2017, p. 669-674.

Research output: Contribution to journalArticle

Xie, JX, Glorioso, TJ, Dattilo, PB, Aggarwal, V, Ho, PM, Barón, AE, Donaldson, D, Armstrong, EJ, Klein, A, Giri, J & Tsai, TT 2017, 'Effect of Chronic Kidney Disease on Mortality in Patients Who Underwent Lower Extremity Peripheral Vascular Intervention', American Journal of Cardiology, vol. 119, no. 4, pp. 669-674. https://doi.org/10.1016/j.amjcard.2016.10.053
Xie, Joe X. ; Glorioso, Thomas J. ; Dattilo, Philip B. ; Aggarwal, Vikas ; Ho, P. Michael ; Barón, Anna E. ; Donaldson, Darcy ; Armstrong, Ehrin J. ; Klein, Andrew ; Giri, Jay ; Tsai, Thomas T. / Effect of Chronic Kidney Disease on Mortality in Patients Who Underwent Lower Extremity Peripheral Vascular Intervention. In: American Journal of Cardiology. 2017 ; Vol. 119, No. 4. pp. 669-674.
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AU - Ho, P. Michael

AU - Barón, Anna E.

AU - Donaldson, Darcy

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AB - 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.

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