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Updated: Nov 19, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Impact of Chronic Kidney Disease on Chronic Total Occlusion Revascularization Outcomes: A Meta-Analysis
Wei-Chieh Lee1,2, Po-Jui Wu1, Chih-Yuan Fang1
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Insights
Chronic kidney disease (CKD) significantly impacts outcomes for patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). While procedural success and mortality rates are worse in CKD patients, revascularization rates remain similar.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- The impact of chronic kidney disease (CKD) on percutaneous coronary intervention (PCI) outcomes for chronic total occlusion (CTO) is not well understood.
- No prior systematic reviews have addressed this specific patient population.
Purpose of the Study:
- To evaluate the clinical outcomes of revascularization in patients with CTO, comparing those with and without CKD.
- To assess the influence of CKD on procedural success, complications, and long-term mortality after PCI for CTO.
Main Methods:
- A systematic review of six studies published between January 2010 and March 2020 was conducted.
- CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2.
- Data on demographics, lesion characteristics, contrast-induced nephropathy (CIN), acute kidney injury (AKI), procedural success, mortality, and revascularization rates were analyzed.
Main Results:
- A significant prevalence of CKD (25.5%) was observed in the CTO population.
- Patients with CKD experienced higher rates of CIN/AKI, lower procedural success, and increased mortality compared to non-CKD patients.
- The incidence of target lesion revascularization (TLR) or target vessel revascularization (TVR) did not differ significantly between the groups.
Conclusions:
- CKD is associated with poorer procedural outcomes and higher mortality in patients undergoing PCI for CTO.
- These adverse outcomes in CKD patients are likely due to more complex lesions and comorbidities.
- Despite differences in success and mortality, revascularization rates (TLR/TVR) were comparable between CKD and non-CKD CTO patients.
Objectives:
To examine the impact of revascularization and associated clinical outcomes of chronic kidney disease (CKD) chronic total occlusion (CTO) and non-CKD CTO groups.
Background:
The influence of CKD on clinical outcomes after percutaneous coronary intervention (PCI) for CTO lesions is unknown, and there is no systemic review of this topic to date.
Methods:
We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials Databases for articles published between 1 January 2010 and 31 March 2020. CKD was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease formula. Data included demographics, lesion distributions, incidence of contrast-induced nephropathy (CIN), acute kidney injury (AKI), procedural success rate, mortality, and target lesion revascularization (TLR)/target vessel revascularization (TVR).
Results:
Six studies were ultimately included in this systematic review. A high prevalence (25.5%; range, 19.6-37.9%) of CKD was noted in the CTO population. In the non-CKD group, outcomes were better: less incidence of CIN or AKI (odds ratio (OR), 2.860; 95% confidence interval (CI), 1.775-4.608), higher procedural success rate (OR, 1.382; 95% CI, 1.036-1.843), and lower long-term mortality (OR, 4.502; 95% CI, 3.561-5.693). The incidence of TLR/TVR (OR, 1.118; 95% CI, 0.888-1.407) did not differ between groups.
Conclusions:
In the CKD CTO PCI population, a lower procedural success rate, a higher incidence of CIN or AKI, and higher in-hospital and long-term mortality rate were noted due to more complex lesions and more comorbidities. However, the incidence of TLR/TVR did not differ between groups.
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