Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France; Department of Tropical Neuroepidemiology, French National Institute of Health and Medical Research, U1094, Limoges, France.
J Vasc Surg. 2013 Oct;58(4):966-71. doi: 10.1016/j.jvs.2013.04.007. Epub 2013 Jun 14.
The aim of the present study was to determine the prevalence of chronic kidney disease (CKD) and its prognostic value in patients hospitalized for lower extremity peripheral artery disease (PAD).
Data from the COhorte des Patients ARTériopathes registry, a prospective multicenter, observational study of consecutive patients hospitalized for PAD in academic hospitals of southwestern France, were analyzed. All the subjects were in Rutherford grade ≥ 3, and 55.6% were in grade ≥ 5-6. Associations between CKD and 1-year mortality, as well as amputation rates, were evaluated by Cox analysis. Kaplan-Meier survival curves were analyzed according to estimated glomerular filtration rate (eGFR).
From May 2004 to January 2009, we enrolled 1010 patients. They were classified into four groups according to the eGFR: 21.7% were in group 1 (≥ 90 mL/min per 1.73 m(2)), 34% in group 2 (60-89 mL/min per 1.73 m(2)), 32.2% in group 3 (30-59 mL/min per 1.73 m(2)), and 12.1% in group 4 (<30 mL/min per 1.73 m(2) including dialysis). All-cause mortality was 25.1% at 1 year. The rate of major amputation was 26.3%. Mortality rates were, respectively, at 16%, 18%, 31.7%, and 44.3% (P < .0001) in groups 1 to 4. The major amputation rates were at 23.7%, 21.5%, 28%, and 40.2% (P = .0006), respectively. The presence of severe CKD (group 4) was associated with all-cause mortality (hazard ratio, 1.84; 95% confidence interval, 1.02-3.32; P = .044). In contrast, the risk of amputation was not associated with CKD after adjustments to risk factors.
The prevalence of CKD in patients hospitalized for PAD is high. CKD is an independent predictor of 1-year mortality, but is not an independent predictor of limb amputation.
本研究旨在确定慢性肾脏病（CKD）在因下肢外周动脉疾病（PAD）住院的患者中的患病率及其预后价值。
分析了法国西南部学术医院住院治疗 PAD 的连续患者的 COhorte des Patients ARTériopathes 登记处前瞻性多中心观察性研究的数据。所有受试者均为 Rutherford 分级≥3 级，其中 55.6%为分级≥5-6 级。通过 Cox 分析评估 CKD 与 1 年死亡率和截肢率之间的关系。根据估计肾小球滤过率（eGFR）分析 Kaplan-Meier 生存曲线。
2004 年 5 月至 2009 年 1 月，我们共纳入 1010 例患者。根据 eGFR 将患者分为四组：21.7%为组 1（≥90 mL/min/1.73 m²），34%为组 2（60-89 mL/min/1.73 m²），32.2%为组 3（30-59 mL/min/1.73 m²），12.1%为组 4（<30 mL/min/1.73 m² 包括透析）。1 年时全因死亡率为 25.1%。主要截肢率为 26.3%。死亡率分别为组 1 至 4 中的 16%、18%、31.7%和 44.3%（P<0.0001）。主要截肢率分别为 23.7%、21.5%、28%和 40.2%（P=0.0006）。严重 CKD（组 4）与全因死亡率相关（危险比，1.84；95%置信区间，1.02-3.32；P=0.044）。相反，调整危险因素后，CKD 与截肢风险无关。
因 PAD 住院的患者 CKD 的患病率较高。CKD 是 1 年死亡率的独立预测因素，但不是肢体截肢的独立预测因素。
