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Updated: Nov 6, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Comparison of Pre-Amputation Evaluation in Patients with and without Chronic Kidney Disease
Nivetha Subramanian1, Jialin Han2, Nicholas J Leeper3
1Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Insights
Patients with chronic kidney disease (CKD) were more likely to receive pre-amputation diagnostic and specialty care. This suggests disparities in access to care do not explain higher amputation rates in CKD patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Health Services Research
Background:
- Patients with chronic kidney disease (CKD) and peripheral artery disease (PAD) face higher risks of lower extremity amputation.
- Understanding pre-amputation care patterns is crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To investigate if patients with CKD receive less pre-amputation care compared to those without CKD.
- To identify potential disparities in diagnostic evaluation, specialty consultations, and revascularization before amputation.
Main Methods:
- Retrospective observational study using a commercial insurance database (2014-2017).
- Identified 8,554 patients with PAD-related lower extremity amputations.
- Analyzed receipt of diagnostic evaluation, specialty care, and revascularization within one year prior to amputation, comparing CKD and non-CKD groups using logistic regression.
Main Results:
- Patients with CKD were more likely to receive diagnostic evaluation (aOR 1.30) and specialty care (aOR 1.45) before amputation.
- No significant difference in lower extremity revascularization rates was observed between CKD and non-CKD patients (aOR 1.03).
- Age, sex, Black race, and diabetes status did not modify these associations.
Conclusions:
- CKD patients demonstrated higher utilization of pre-amputation diagnostic and specialty care.
- The findings do not support the hypothesis that access disparities in pre-amputation care explain elevated amputation rates among CKD patients.
- Further research into other contributing factors for higher amputation rates in CKD patients is warranted.
Introduction:
Patients with chronic kidney disease (CKD) and peripheral artery disease (PAD) are more likely to undergo lower extremity amputation than patients with preserved kidney function. We sought to determine whether patients with CKD were less likely to receive pre-amputation care in the 1-year prior to lower extremity amputation compared to patients without CKD.
Methods:
We conducted a retrospective observational study of patients with PAD-related lower extremity amputation between January 2014 and December 2017 using a large commercial insurance database. The primary exposure was CKD identified using billing codes and laboratory values. The primary outcomes were receipt of pre-amputation care, defined as diagnostic evaluation (ankle-brachial index, duplex ultrasound, and computed tomographic angiography), specialty care (vascular surgery, cardiology, orthopedic surgery, and podiatry), and lower extremity revascularization in the 1-year prior to amputation. We conducted separate logistic regression models to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CIs) among patients with and without CKD. We assessed for effect modification by age, sex, Black race, and diabetes status.
Results:
We identified 8,554 patients with PAD-related amputation. In fully adjusted models, patients with CKD were more likely to receive diagnostic evaluation (aOR 1.30; 95% CI 1.17-1.44) and specialty care (aOR 1.45, 95% CI 1.27-1.64) in the 1-year prior to amputation. There was no difference in odds of revascularization by CKD status (aOR 1.03, 0.90-1.19). Age, sex, Black race, and diabetes status did not modify these associations.
Discussion/Conclusion:
Patients with CKD had higher odds of receiving diagnostic testing and specialty care and similar odds of lower extremity revascularization in the 1-year prior to amputation than patients without CKD. Disparities in access to pre-amputation care do not appear to explain the higher amputation rates seen among patients with CKD.
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