Long-Term Mortality After Invasive Angiography and Endovascular Revascularization in Patients With PAD Having Chronic
Katrin Gebauer1, Christiane Engelbertz2, Nasser M Malyar2
1Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany gebauek@ukmuenster.de.
Insights
Peripheral arterial disease (PAD) and chronic kidney disease (CKD) significantly impact survival. Advanced CKD stages in PAD patients correlate with higher mortality, underscoring kidney function
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Clinical Outcomes Research
Background:
- Peripheral arterial disease (PAD) and chronic kidney disease (CKD) are independently linked to increased mortality.
- The combined impact of PAD and CKD on long-term patient outcomes requires further investigation.
Purpose of the Study:
- To assess the long-term survival and outcomes of patients with PAD, stratified by the severity of their chronic kidney disease.
- To identify predictors of mortality in patients with coexisting PAD and CKD.
Main Methods:
- Retrospective analysis of 572 patients with PAD undergoing invasive angiography or endovascular revascularization between 2005-2010.
- Patients were classified into five CKD stages based on renal function.
- Long-term follow-up was conducted to record cumulative mortality.
Main Results:
- Cumulative mortality was 21% over a mean follow-up of 1135 days, increasing significantly with advanced CKD stages (9% to 47%).
- Higher CKD stages were independently associated with poorer long-term survival in multivariate Cox regression models.
- Medication adherence for secondary prevention was suboptimal and did not differ across CKD stages.
Conclusions:
- Kidney function is a critical independent predictor of worse long-term survival in patients with PAD.
- The severity of CKD significantly influences mortality risk in PAD patients.
- Suboptimal medication adherence for secondary prevention is prevalent but not stage-dependent in this cohort.
Abstract:
Peripheral arterial disease (PAD) and chronic kidney disease (CKD) are associated with increased mortality rates. We assessed long-term outcomes of patients with PAD and CKD. Patients with PAD undergoing invasive angiography and/or endovascular revascularization between 2005 and 2010 were retrospectively classified into 5 CKD stages. A follow-up was performed and 572 patients were included, 116 patients (20%) had normal renal function, 245 were in CKD stage 2 (43%), 156 in CKD stage 3 (27%), and 55 in CKD stages 4 + 5 (10%). Diabetes mellitus, hypertension, and anemia were more frequent in higher CKD stages (P < .03). During follow-up (mean 1135 days; 95% confidence interval 1159-1259), cumulative mortality was 21% and increased with advanced CKD stages (9%, 16%, 29%, and 47%, respectively, P < .001). In multivariate Cox regression models, higher CKD stages were significantly associated with poor survival. Medication adherence for secondary prevention was significantly lower than recommended but irrespective of CKD stages. Kidney function is an independent predictor of worse long-term survival in patients with PAD. While standard medications were used less often than recommended, no differences between CKD stages were noted.
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