Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS.
Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN.
J Vasc Surg. 2024 May;79(5):1170-1178.e10. doi: 10.1016/j.jvs.2024.01.016. Epub 2024 Jan 19.
Patients with peripheral artery disease (PAD) and end-stage kidney disease are a high-risk population, and concomitant atherosclerosis in coronary arteries (CAD) or cerebral arteries (CVD) is common. The aim of the study was to assess long-term outcomes of PAD and the impact of coexistent CAD and CVD on outcomes.
The United States Renal Data System was used to identify patients with PAD within 6 months of incident dialysis. Four groups were formed: PAD alone, PAD with CAD, PAD with CVD, and PAD with CAD and CVD. PAD-specific outcomes (chronic limb-threatening ischemia, major amputation, percutaneous/surgical revascularization, and their composite, defined as major adverse limb events [MALE]) as well as all-cause mortality, myocardial infarction, and stroke were studied.
The study included 106,567 patients (mean age, 71.2 years; 40.8% female) with a median follow-up of 546 days (interquartile range, 214-1096 days). Most patients had PAD and CAD (49.8%), 25.8% had PAD alone, and 19.2% had all three territories involved. MALE rate in patients with PAD was 22.3% and 35.0% at 1 and 3 years, respectively. In comparison to PAD alone, the coexistence of both CAD and CVD (ie, polyvascular disease) was associated with a higher adjusted rates of all-cause mortality (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.24-1.31), myocardial infarction (HR, 1.78; 95% CI, 1.69-1.88), stroke (HR, 1.66; 95% CI, 1.52,1.80), and MALE (HR, 1.07; 95% CI, 1.04-1.11).
Patients with end-stage kidney disease have a high burden of PAD with poor long-term outcomes, which worsen, in an incremental fashion, with the involvement of each additional diseased arterial bed.
患有外周动脉疾病（PAD）和终末期肾病的患者属于高危人群，其冠状动脉（CAD）或脑动脉（CVD）并存的动脉粥样硬化也很常见。本研究旨在评估 PAD 的长期结局，以及并存 CAD 和 CVD 对结局的影响。
本研究使用美国肾脏数据系统（USRDS）在透析开始后 6 个月内确定 PAD 患者。将患者分为四组：单纯 PAD 组、PAD 合并 CAD 组、PAD 合并 CVD 组和 PAD 合并 CAD 和 CVD 组。研究了 PAD 特异性结局（慢性肢体威胁性缺血、主要截肢、经皮/手术血运重建及其复合结局，定义为主要不良肢体事件 [MALE]）以及全因死亡率、心肌梗死和卒中等。
本研究纳入了 106567 名（平均年龄 71.2 岁，40.8%为女性）患者，中位随访时间为 546 天（四分位距 214-1096 天）。大多数患者存在 PAD 和 CAD（49.8%），25.8%为单纯 PAD，19.2%存在所有三个部位的病变。PAD 患者的 MALE 发生率分别为 22.3%和 35.0%，在 1 年和 3 年时。与单纯 PAD 相比，CAD 和 CVD 的并存（即多血管疾病）与更高的全因死亡率（风险比 [HR]，1.28；95%置信区间 [CI]，1.24-1.31）、心肌梗死（HR，1.78；95%CI，1.69-1.88）、卒中和 MALE（HR，1.07；95%CI，1.04-1.11）调整后发生率相关。
终末期肾病患者的 PAD 负担很重，长期预后不佳，随着每个额外患病动脉床的累及，结局呈递增性恶化。
