Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
Eur J Vasc Endovasc Surg. 2022 Aug-Sep;64(2-3):225-233. doi: 10.1016/j.ejvs.2022.03.045. Epub 2022 Apr 26.
Revascularisation for peripheral artery disease (PAD) is increasingly common in dialysis patients. Patients with PAD who have undergone revascularisation are at high risk of subsequent complications. Malnutrition is an important modifiable risk factor for dialysis patients, yet few data exist on the prognostic impact of malnutrition on post-procedure long term outcomes. The objective was to assess the prevalence and prognostic association of malnutrition using the Controlling Nutritional Status (CONUT) score in a prospective cohort of dialysis patients undergoing endovascular therapy (EVT) for PAD.
A total of 395 consecutive dialysis patients undergoing endovascular revascularisation for lower extremity PAD between 2005 and 2019 were examined for the primary outcome of all cause death. Secondary outcomes included major adverse limb events (MALEs), defined as acute limb ischaemia, major amputation, and clinically driven revascularisation; and major adverse cardiovascular events (MACEs). Nutritional status was assessed by CONUT score, a screening tool for malnutrition, incorporating albumin, cholesterol, and total lymphocyte count.
According to the CONUT score, 40.8% of patients were moderately or severely malnourished. During a median follow up of 2.2 years, 218 (55.2%) patients died; 211 (53.4%) patients had MALEs, and MACEs occurred in 135 (34.2%) patients. Compared with normal nutritional status, severe malnutrition was associated with a significantly increased risk of all cause death (adjusted hazard ration [aHR] 4.83, 95% confidence interval [CI] 2.56 - 9.12) and MALEs (aHR 2.42, 95% CI 1.23 - 4.74) but not MACEs (aHR 1.81, 95% CI 0.74 - 4.40). Similar results were observed when the CONUT score was analysed as a continuous variable.
Malnutrition is common in dialysis patients with PAD requiring endovascular therapy and is strongly associated with increased death and MALEs. Clinical trials are needed to evaluate whether nutritional interventions improve outcomes for dialysis patients after peripheral revascularisation.
外周动脉疾病（PAD）的血运重建在透析患者中越来越常见。接受血运重建的 PAD 患者随后发生并发症的风险很高。营养不良是透析患者一个重要的可改变的危险因素，但关于营养不良对术后长期预后的影响的预后数据很少。本研究旨在通过使用控制营养状况（CONUT）评分评估接受血管内治疗（EVT）的 PAD 透析患者中营养不良的患病率和预后相关性。
共纳入 2005 年至 2019 年期间接受下肢 PAD 血管内血运重建的 395 例连续透析患者，主要结局为全因死亡。次要结局包括主要不良肢体事件（MALEs），定义为急性肢体缺血、大截肢和临床驱动的血运重建；以及主要不良心血管事件（MACEs）。营养状况通过 CONUT 评分评估，CONUT 评分是一种营养不良的筛查工具，包括白蛋白、胆固醇和总淋巴细胞计数。
根据 CONUT 评分，40.8%的患者存在中度或重度营养不良。在中位数为 2.2 年的随访期间，218 例（55.2%）患者死亡；211 例（53.4%）患者发生 MALEs，135 例（34.2%）患者发生 MACEs。与营养状况正常相比，严重营养不良与全因死亡（调整后的危险比[HR] 4.83，95%置信区间[CI] 2.56-9.12）和 MALEs（调整后的 HR 2.42，95%CI 1.23-4.74）显著增加的风险相关，但与 MACEs（调整后的 HR 1.81，95%CI 0.74-4.40）无关。当连续变量分析 CONUT 评分时，观察到了类似的结果。
需要进行临床试验来评估营养干预是否可以改善透析患者外周血运重建后的预后。在需要接受血管内治疗的 PAD 透析患者中，营养不良很常见，并且与死亡率和 MALEs 增加密切相关。
