Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA; Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY, USA.
Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
Atherosclerosis. 2020 Mar;297:149-156. doi: 10.1016/j.atherosclerosis.2019.12.016. Epub 2019 Dec 24.
BACKGROUND & AIMS: Renal disease is a risk factor for peripheral artery disease (PAD), yet its impact on outcomes after lower extremity (LE) revascularization is not well established. We aimed to characterize the association between chronic kidney disease (CKD) and/or end stage renal disease (ESRD) and post-procedural outcomes in PAD patients undergoing LE revascularization in the United States.
Adults age ≥18 years undergoing surgical or endovascular LE revascularization for PAD with and without CKD or ESRD were identified from the 2014 Nationwide Readmissions Database. Major adverse cardiovascular events (MACE), defined as a composite of death, myocardial infarction or ischemic stroke, were identified for patients with and without renal disease. All-cause hospital readmissions within 6 months of discharge were determined for all survivors.
Among 39,441 patients with PAD hospitalized for LE revascularization, 10,530 had renal disease (26.7%), of whom 69% had CKD without ESRD and 31% had ESRD. Patients with renal disease were more likely to have MACE after LE revascularization (5.2% vs. 2.5%; adjusted OR [aOR] 1.74, 95% CI 1.40-2.16), require LE amputation (26.1% vs. 12.2%; aOR 1.33, 95% CI 1.19-1.50), and require hospital readmission within 6 months (61.0% vs. 43.6%; adjusted HR [aHR] 1.38, 95% CI 1.28-1.48) compared to those without renal disease.
Renal disease is common among patients undergoing LE revascularization for PAD and was independently associated with in-hospital MACE, LE amputation, and hospital readmission within 6 months. Additional efforts to improve outcomes of patients with renal disease and PAD requiring LE revascularization are necessary.
肾脏疾病是外周动脉疾病（PAD）的一个危险因素，但它对下肢（LE）血运重建后结局的影响尚未得到充分证实。我们旨在描述美国接受 LE 血运重建的 PAD 患者中慢性肾脏病（CKD）和/或终末期肾病（ESRD）与术后结果之间的关系。
从 2014 年全国再入院数据库中确定了年龄≥18 岁，因 PAD 接受手术或血管内 LE 血运重建，伴或不伴 CKD 或 ESRD 的成年人。确定有无肾脏疾病的患者的主要心血管不良事件（MACE），定义为死亡、心肌梗死或缺血性卒中的复合事件。所有幸存者在出院后 6 个月内的全因住院再入院情况。
在 39441 例因 PAD 住院接受 LE 血运重建的患者中，有 10530 例患有肾脏疾病（26.7%），其中 69%为无 ESRD 的 CKD，31%为 ESRD。与无肾脏疾病的患者相比，LE 血运重建后发生 MACE 的患者更有可能发生肾脏疾病（5.2% vs. 2.5%；调整后的 OR [aOR] 1.74，95%CI 1.40-2.16）、需要 LE 截肢（26.1% vs. 12.2%；aOR 1.33，95%CI 1.19-1.50）和在 6 个月内需要住院再入院（61.0% vs. 43.6%；调整后的 HR [aHR] 1.38，95%CI 1.28-1.48）。
肾脏疾病在因 PAD 接受 LE 血运重建的患者中很常见，与住院期间 MACE、LE 截肢和 6 个月内住院再入院独立相关。需要进一步努力改善需要 LE 血运重建的患有肾脏疾病和 PAD 的患者的结局。
