Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease

Paul P. Heideman, Mohammad Reza Rajebi, Michael A. McKusick, Haraldur Bjarnason, Gustavo Oderich, Jeremy L. Friese, Mark D. Fleming, Andrew H. Stockland, William S. Harmsen, Jayawant Mandrekar, Sanjay Misra

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose To evaluate effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE and postoperative death (MALE + POD), and amputation after endovascular treatment of femoropopliteal disease. Materials and Methods A retrospective review from January 2002 to October 2011 was performed of 440 patients who underwent endovascular treatment of symptomatic femoropopliteal disease for claudication (n = 251) or critical limb ischemia (CLI) (n = 267). CKD stage was divided based on Kidney Dialysis Outcomes Quality Initiative classification. Outcomes and factors associated with amputation, MALE, and MALE + POD were determined. Results Patients with diabetes (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.3–3.6; P =.002) and runoff score of 0 or 1 (HR = 2.0; 95% CI, 1.2–3.4; P =.01) relative to runoff score of 3 were at increased risk of amputation. Patients with baseline glomerular filtration rate < 45 mL/min/1.73 m2 had a 17% increase in amputation for every 5-point decrease < 45 mL/min/1.73 m2 (95% CI, 1.09–1.26; P <.001). Increase of 10 years in age (HR = 1.9; 95% CI, 1.5–2.3; P <.001), TransAtlantic Inter-Society Consensus class of C/D relative to A/B (HR = 1.6; 95% CI, 1.1–2.2; P =.01), and CLI (HR = 2.4; 95% CI, 0.5–0.9; P <.001) were associated with increased mortality. Female sex was associated with decreased risk of mortality (HR = 0.7; 95% CI, 0.5–0.9; P =.01). Conclusions Worsening CKD is associated with higher amputation rates, all-cause mortality, and MALE + POD in patients undergoing endovascular treatment of femoropopliteal disease.

Original languageEnglish (US)
Pages (from-to)1204-1214
Number of pages11
JournalJournal of Vascular and Interventional Radiology
Volume27
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Chronic Renal Insufficiency
Extremities
Amputation
Confidence Intervals
Mortality
Ischemia
Glomerular Filtration Rate
Dialysis
Therapeutics
Kidney

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease. / Heideman, Paul P.; Rajebi, Mohammad Reza; McKusick, Michael A.; Bjarnason, Haraldur; Oderich, Gustavo; Friese, Jeremy L.; Fleming, Mark D.; Stockland, Andrew H.; Harmsen, William S.; Mandrekar, Jayawant; Misra, Sanjay.

In: Journal of Vascular and Interventional Radiology, Vol. 27, No. 8, 01.08.2016, p. 1204-1214.

Research output: Contribution to journalArticle

Heideman, Paul P. ; Rajebi, Mohammad Reza ; McKusick, Michael A. ; Bjarnason, Haraldur ; Oderich, Gustavo ; Friese, Jeremy L. ; Fleming, Mark D. ; Stockland, Andrew H. ; Harmsen, William S. ; Mandrekar, Jayawant ; Misra, Sanjay. / Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease. In: Journal of Vascular and Interventional Radiology. 2016 ; Vol. 27, No. 8. pp. 1204-1214.
@article{1e84cfabb5eb4fe6a9b5b9bfc417cbb5,
title = "Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease",
abstract = "Purpose To evaluate effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE and postoperative death (MALE + POD), and amputation after endovascular treatment of femoropopliteal disease. Materials and Methods A retrospective review from January 2002 to October 2011 was performed of 440 patients who underwent endovascular treatment of symptomatic femoropopliteal disease for claudication (n = 251) or critical limb ischemia (CLI) (n = 267). CKD stage was divided based on Kidney Dialysis Outcomes Quality Initiative classification. Outcomes and factors associated with amputation, MALE, and MALE + POD were determined. Results Patients with diabetes (hazard ratio [HR] = 2.2; 95{\%} confidence interval [CI], 1.3–3.6; P =.002) and runoff score of 0 or 1 (HR = 2.0; 95{\%} CI, 1.2–3.4; P =.01) relative to runoff score of 3 were at increased risk of amputation. Patients with baseline glomerular filtration rate < 45 mL/min/1.73 m2 had a 17{\%} increase in amputation for every 5-point decrease < 45 mL/min/1.73 m2 (95{\%} CI, 1.09–1.26; P <.001). Increase of 10 years in age (HR = 1.9; 95{\%} CI, 1.5–2.3; P <.001), TransAtlantic Inter-Society Consensus class of C/D relative to A/B (HR = 1.6; 95{\%} CI, 1.1–2.2; P =.01), and CLI (HR = 2.4; 95{\%} CI, 0.5–0.9; P <.001) were associated with increased mortality. Female sex was associated with decreased risk of mortality (HR = 0.7; 95{\%} CI, 0.5–0.9; P =.01). Conclusions Worsening CKD is associated with higher amputation rates, all-cause mortality, and MALE + POD in patients undergoing endovascular treatment of femoropopliteal disease.",
author = "Heideman, {Paul P.} and Rajebi, {Mohammad Reza} and McKusick, {Michael A.} and Haraldur Bjarnason and Gustavo Oderich and Friese, {Jeremy L.} and Fleming, {Mark D.} and Stockland, {Andrew H.} and Harmsen, {William S.} and Jayawant Mandrekar and Sanjay Misra",
year = "2016",
month = "8",
day = "1",
doi = "10.1016/j.jvir.2016.04.036",
language = "English (US)",
volume = "27",
pages = "1204--1214",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
publisher = "Elsevier Inc.",
number = "8",

}

TY - JOUR

T1 - Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease

AU - Heideman, Paul P.

AU - Rajebi, Mohammad Reza

AU - McKusick, Michael A.

AU - Bjarnason, Haraldur

AU - Oderich, Gustavo

AU - Friese, Jeremy L.

AU - Fleming, Mark D.

AU - Stockland, Andrew H.

AU - Harmsen, William S.

AU - Mandrekar, Jayawant

AU - Misra, Sanjay

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Purpose To evaluate effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE and postoperative death (MALE + POD), and amputation after endovascular treatment of femoropopliteal disease. Materials and Methods A retrospective review from January 2002 to October 2011 was performed of 440 patients who underwent endovascular treatment of symptomatic femoropopliteal disease for claudication (n = 251) or critical limb ischemia (CLI) (n = 267). CKD stage was divided based on Kidney Dialysis Outcomes Quality Initiative classification. Outcomes and factors associated with amputation, MALE, and MALE + POD were determined. Results Patients with diabetes (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.3–3.6; P =.002) and runoff score of 0 or 1 (HR = 2.0; 95% CI, 1.2–3.4; P =.01) relative to runoff score of 3 were at increased risk of amputation. Patients with baseline glomerular filtration rate < 45 mL/min/1.73 m2 had a 17% increase in amputation for every 5-point decrease < 45 mL/min/1.73 m2 (95% CI, 1.09–1.26; P <.001). Increase of 10 years in age (HR = 1.9; 95% CI, 1.5–2.3; P <.001), TransAtlantic Inter-Society Consensus class of C/D relative to A/B (HR = 1.6; 95% CI, 1.1–2.2; P =.01), and CLI (HR = 2.4; 95% CI, 0.5–0.9; P <.001) were associated with increased mortality. Female sex was associated with decreased risk of mortality (HR = 0.7; 95% CI, 0.5–0.9; P =.01). Conclusions Worsening CKD is associated with higher amputation rates, all-cause mortality, and MALE + POD in patients undergoing endovascular treatment of femoropopliteal disease.

AB - Purpose To evaluate effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE and postoperative death (MALE + POD), and amputation after endovascular treatment of femoropopliteal disease. Materials and Methods A retrospective review from January 2002 to October 2011 was performed of 440 patients who underwent endovascular treatment of symptomatic femoropopliteal disease for claudication (n = 251) or critical limb ischemia (CLI) (n = 267). CKD stage was divided based on Kidney Dialysis Outcomes Quality Initiative classification. Outcomes and factors associated with amputation, MALE, and MALE + POD were determined. Results Patients with diabetes (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.3–3.6; P =.002) and runoff score of 0 or 1 (HR = 2.0; 95% CI, 1.2–3.4; P =.01) relative to runoff score of 3 were at increased risk of amputation. Patients with baseline glomerular filtration rate < 45 mL/min/1.73 m2 had a 17% increase in amputation for every 5-point decrease < 45 mL/min/1.73 m2 (95% CI, 1.09–1.26; P <.001). Increase of 10 years in age (HR = 1.9; 95% CI, 1.5–2.3; P <.001), TransAtlantic Inter-Society Consensus class of C/D relative to A/B (HR = 1.6; 95% CI, 1.1–2.2; P =.01), and CLI (HR = 2.4; 95% CI, 0.5–0.9; P <.001) were associated with increased mortality. Female sex was associated with decreased risk of mortality (HR = 0.7; 95% CI, 0.5–0.9; P =.01). Conclusions Worsening CKD is associated with higher amputation rates, all-cause mortality, and MALE + POD in patients undergoing endovascular treatment of femoropopliteal disease.

UR - http://www.scopus.com/inward/record.url?scp=84990963162&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990963162&partnerID=8YFLogxK

U2 - 10.1016/j.jvir.2016.04.036

DO - 10.1016/j.jvir.2016.04.036

M3 - Article

C2 - 27321888

AN - SCOPUS:84990963162

VL - 27

SP - 1204

EP - 1214

JO - Journal of Vascular and Interventional Radiology

JF - Journal of Vascular and Interventional Radiology

SN - 1051-0443

IS - 8

ER -