Shah Samir K, Neal Dan, Vasilopoulos Terrie, Segal Mark, Berceli Scott, Weissman Joel S
Division of Vascular Surgery, University of Florida, Gainesville, FL.
Department of Surgery, University of Florida, Gainesville, FL.
Ann Surg. 2024 Oct 15. doi: 10.1097/SLA.0000000000006566.
To understand mortality and secondary outcomes in patients with both end-stage kidney disease (ESKD) and chronic limb-threatening ischemia (CLTI) after no procedural treatment, primary amputation, endovascular treatment, and open surgery.
ESKD and CLTI commonly cooccur and limited prior work has demonstrated poor outcomes including one-year survival despite treatment.
We conducted a retrospective national cohort study of United States Renal Data System data from January 1, 2016 to December 31, 2019 to determine mortality, major postoperative complications, and other outcomes. We performed an exploratory analysis comparing two-year survival by treatment using propensity matching.
Of 1,876,652 records with a CLTI diagnosis, we identified 3,908 patients with ESKD and an incident CLTI diagnosis. Mean age at CLTI diagnosis was 65.7 years and 2,405 (61.5%) were male. 2,696 (69.0%) had no procedural treatment, 609 (15.6%) had major limb amputation, 439 (11.2%) had endovascular treatment, and 164 (4.2%) had open surgery. There was 44.9% mortality at one year, along with 41.8% major postoperative complications and 52.6% readmissions at 90 days. Comparing two-year survival, we found no differences between the amputation and endovascular cohorts ( P =0.08) and between endovascular and open ( P =.06). There was superior two-year survival in the open surgery cohort compared to the amputation cohort ( P =0.002).
Patients living with both ESKD and CLTI experience poor outcomes irrespective of treatment. Exploratory analyses demonstrated that two-year survival among the three principal procedural treatments was similar except for superior survival among patients undergoing open therapy compared to primary amputation.
了解终末期肾病（ESKD）合并慢性肢体威胁性缺血（CLTI）患者在未接受手术治疗、一期截肢、血管内治疗和开放手术后的死亡率及次要结局。
ESKD和CLTI常同时出现，既往有限的研究表明，尽管进行了治疗，但包括一年生存率在内的结局仍较差。
我们对2016年1月1日至2019年12月31日美国肾脏数据系统的数据进行了一项回顾性全国队列研究，以确定死亡率、主要术后并发症及其他结局。我们使用倾向匹配法进行了一项探索性分析，比较不同治疗方式的两年生存率。
在1876652条有CLTI诊断记录中，我们识别出3908例ESKD合并新发CLTI诊断的患者。CLTI诊断时的平均年龄为65.7岁，2405例（61.5%）为男性。2696例（69.0%）未接受手术治疗，609例（15.6%）进行了大肢体截肢，439例（11.2%）接受了血管内治疗，164例（4.2%）接受了开放手术。一年时的死亡率为44.9%，主要术后并发症发生率为41.8%，90天时再入院率为52.6%。比较两年生存率，我们发现截肢组和血管内治疗组之间（P = 0.08）以及血管内治疗组和开放手术组之间（P = 0.06）无差异。开放手术组的两年生存率高于截肢组（P = 0.002）。
ESKD合并CLTI的患者无论接受何种治疗，结局均较差。探索性分析表明，三种主要手术治疗方式的两年生存率相似，但接受开放治疗的患者生存率高于一期截肢患者。
