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
Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
Division of Cardiology, VA Eastern Colorado Health Care System, Denver, Colorado.
Am J Cardiol. 2017 Feb 15;119(4):669-674. doi: 10.1016/j.amjcard.2016.10.053. Epub 2016 Nov 16.
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.
已知慢性肾脏病（CKD）与接受下肢手术血运重建的外周动脉疾病患者术后发病率和死亡率增加相关；然而，外周血管介入治疗（PVI）后的结局尚不明确。本研究旨在确定CKD对接受PVI的外周动脉疾病患者不良结局的影响。利用退伍军人事务部临床评估、报告和跟踪系统项目的数据，我们确定了一组755例于2005年6月至2010年8月在33个地点接受下肢PVI的患者。感兴趣的结局包括死亡率、进展至透析、心肌梗死、肢体截肢和中风。Kaplan-Meier生存分析和Cox比例风险脆弱模型评估了CKD与不良结局之间的关联。在接受下肢PVI的患者中，201例（27%）患有CKD。CKD的存在与生存率降低相关（CKD与非CKD的5年生存概率：49.9%[41.6%至59.9%]对80.1%[76.2%至84.1%]），风险调整后该关联仍然存在（HR 1.57；95%置信区间1.13至2.19）。此外，CKD与进展至透析之间存在显著关联（HR 6.62；95%置信区间2.25至19.43）。相比之下，CKD与因心肌梗死、肢体截肢或中风再次住院之间无关联。总之，接受PVI的患者中有四分之一患有CKD，且与死亡率增加和进展至透析的风险增加相关。
