Wang Peng, Yang Fei, Yin Jing, Zhu Huajian, Zhang Meng, Liu Caixiang
Department of Interventional and Vascular Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China.
Department of Surgery of Traditional Chinese Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China.
Ann Palliat Med. 2021 Apr;10(4):4661-4669. doi: 10.21037/apm-21-648.
Critical limb artery ischemia is one of common complications after hemodialysis, with endovascular therapy (EVT) having become its first-line treatment. There is no relevant study investigating the relationship between EVT and the prognosis of hemodialysis patients with critical lower limb ischemia, the most common site of vascular dysfunction.
This was a retrospective, nonrandomized, single-center study. Hemodialysis patients with critical lower limb ischemia between May 2015 and October 2018 were included in this study. Their demographic and clinical data and the results of laboratory test were collected. The outcomes included all-cause mortality, amputation, and revascularization. Kaplan-Meier analysis and log-rank test were used to assess overall survival and amputation-free survival. Univariable and multivariable hazard Cox regression analyses were performed to determine risk factors of amputation and mortality.
In all, 67 hemodialysis patients were finally included in this study. The median age of included patients was 69.8±8.7 years, and the median duration of hemodialysis was 44.1±9.2 months. There was no significant difference between patients receiving and not receiving EVT in collected demographic and clinical data except for the duration of hemodialysis (46.1±9.0 vs. 41.7±9.0 months; P=0.048). The level of high-density lipoprotein cholesterol (HDL-C) in patients receiving EVT was 1.4±0.6 mmol/L, which was significantly lower than the 1.9±0.6 mmol/L in patients not receiving EVT (P<0.001). The results from the Kaplan-Meier curves indicated that the incidences of all-cause mortality and amputation were much lower in patients receiving EVT than in those not receiving EVT (P=0.038 and P=0.020). Hazard Cox regression analysis also indicated that EVT played protective role in all-cause mortality and amputation in hemodialysis patients with lower limb ischemia. Age, nutritional risk, stroke, and C-reactive protein (CRP) were also determined as independent risk factors of all-cause mortality according to multivariable analysis. Additionally, duration of hemodialysis and smoking history were identified as independent risk factors of amputation.
EVT could be an efficient treatment for critical lower limb ischemia in hemodialysis patients to reduce all-cause mortality and the incidence of amputation. Moreover, some risk factors, such as malnutritional and stroke, should be avoided to improve the prognosis of hemodialysis patients.
严重肢体动脉缺血是血液透析后常见的并发症之一，血管内治疗（EVT）已成为其一线治疗方法。目前尚无相关研究探讨EVT与最常见的血管功能障碍部位——严重下肢缺血的血液透析患者预后之间的关系。
这是一项回顾性、非随机、单中心研究。纳入2015年5月至2018年10月期间患有严重下肢缺血的血液透析患者。收集他们的人口统计学和临床数据以及实验室检查结果。结局指标包括全因死亡率、截肢和血管再通。采用Kaplan-Meier分析和对数秩检验评估总生存率和无截肢生存率。进行单变量和多变量风险Cox回归分析以确定截肢和死亡的危险因素。
最终共有67例血液透析患者纳入本研究。纳入患者的中位年龄为69.8±8.7岁，中位血液透析时间为44.1±9.2个月。在收集的人口统计学和临床数据中，接受和未接受EVT的患者之间除血液透析时间外无显著差异（46.1±9.0 vs. 41.7±9.0个月；P = 0.048）。接受EVT的患者高密度脂蛋白胆固醇（HDL-C）水平为1.4±0.6 mmol/L，显著低于未接受EVT的患者的1.9±0.6 mmol/L（P < 0.001）。Kaplan-Meier曲线结果表明，接受EVT的患者全因死亡率和截肢发生率远低于未接受EVT的患者（P = 0.038和P = 0.020）。风险Cox回归分析还表明，EVT对下肢缺血的血液透析患者的全因死亡率和截肢具有保护作用。根据多变量分析，年龄、营养风险、中风和C反应蛋白（CRP）也被确定为全因死亡率的独立危险因素。此外，血液透析时间和吸烟史被确定为截肢的独立危险因素。
EVT可能是治疗血液透析患者严重下肢缺血的有效方法，可降低全因死亡率和截肢发生率。此外，应避免一些危险因素，如营养不良和中风，以改善血液透析患者的预后。
