Li Kevin, Ferguson Thomas, Embil John, Rigatto Claudio, Komenda Paul, Tangri Navdeep
Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
Kidney Int Rep. 2020 Dec 4;6(2):381-388. doi: 10.1016/j.ekir.2020.11.010. eCollection 2021 Feb.
Lower limb complications are major adverse events in patients with peripheral artery disease (PAD) and chronic kidney disease (CKD). These complications can lead to morbidity, disability, reduced quality of life, and higher health care costs. We sought to determine how interim lower limb complications modify the subsequent risk of progression to kidney failure, all-cause mortality before kidney failure, and cardiovascular (CV) events in a cohort of patients with CKD stages G3 to G5.
We performed a retrospective cohort study using patient-level data obtained by linking several administrative databases from Manitoba, Canada. We used Fine and Gray regression models for the primary outcomes of (1) kidney failure adjusted for the competing risk of all-cause mortality, (2) death before kidney failure, and (3) cardiovascular-related hospitalization with the competing risk of non-CV death.
A total of 92,618 patients were included in the final cohort, with a median follow-up time of 2.56 years. Compared with patients who did not experience an interim lower limb complication, there was a higher risk of kidney failure (adjusted hazard ratio [HR] 2.51, 95% confidence interval [CI] 2.10-3.00), all-cause mortality before kidney failure (adjusted HR 2.73, 95% CI 2.55-2.92), and CV events (adjusted HR 2.12, 95% CI 1.90-2.38).
Interim lower limb complications are associated with an increased risk of kidney failure, all-cause mortality before kidney failure, and cardiovascular-related hospitalization. Clinical trials of screening and treatment strategies for patients with CKD at risk for lower limb complications may help determine optimal strategies to manage this risk.
下肢并发症是外周动脉疾病（PAD）和慢性肾脏病（CKD）患者的主要不良事件。这些并发症可导致发病、残疾、生活质量下降以及更高的医疗费用。我们试图确定在一组G3至G5期CKD患者中，中期下肢并发症如何改变随后进展至肾衰竭、肾衰竭前全因死亡率以及心血管（CV）事件的风险。
我们使用通过链接加拿大曼尼托巴省的几个行政数据库获得的患者层面数据进行了一项回顾性队列研究。我们使用Fine和Gray回归模型来分析以下主要结局：（1）针对全因死亡率的竞争风险进行调整后的肾衰竭；（2）肾衰竭前死亡；（3）与非CV死亡的竞争风险相关的心血管相关住院治疗。
最终队列共纳入92,618名患者，中位随访时间为2.56年。与未经历中期下肢并发症的患者相比，发生肾衰竭的风险更高（调整后的风险比[HR]为2.51，95%置信区间[CI]为2.10 - 3.00）、肾衰竭前全因死亡率更高（调整后的HR为2.73，95% CI为2.55 - 2.92）以及CV事件风险更高（调整后的HR为2.12，95% CI为1.90 - 2.38）。
中期下肢并发症与肾衰竭、肾衰竭前全因死亡率以及心血管相关住院治疗风险增加相关。针对有下肢并发症风险的CKD患者的筛查和治疗策略的临床试验可能有助于确定管理该风险的最佳策略。
