Related Experiment Video
Updated: Jun 28, 2025
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Moderate and Severe Chronic Kidney Disease Predict Greater 5-Year Mortality following Major Lower-Extremity
Luke T Pitsenbarger1, Maria N Som1, Natalie T Chao1
1Department of Surgery, Vascular Division, University of Maryland School of Medicine, Baltimore, MD, USA.
Insights
Patients with chronic kidney disease (CKD) face higher mortality after major lower-extremity amputation (LEA). Even mild CKD increases long-term survival risks, highlighting the need for preoperative kidney function assessment.
Area of Science:
- Nephrology
- Vascular Surgery
- Outcomes Research
Background:
- Severe chronic kidney disease (CKD) is a known predictor of mortality post-major lower-extremity amputation (LEA).
- The impact of earlier stages of CKD on mortality after LEA is not well understood.
- Understanding these risks is crucial for patient management and surgical decision-making.
Purpose of the Study:
- To investigate the association between chronic kidney disease (CKD) and long-term mortality after major lower-extremity amputation (LEA).
- To determine if different stages of CKD influence postoperative survival rates.
- To identify potential risk factors and inform clinical practice for patients undergoing LEA.
Main Methods:
- Retrospective chart review of 565 patients undergoing atraumatic major LEA between 2015 and 2021.
- Patients were stratified based on renal function (CKD stages).
- Long-term postoperative outcomes, including survival, were compared using Kaplan-Meier and Cox Regression analyses.
Main Results:
- Preoperative CKD was associated with patient characteristics, comorbidities, reduced follow-up, and lower survival.
- Patients with mild, moderate, or severe CKD had significantly worse 5-year survival post-LEA compared to those without CKD (P < 0.001).
- Severe CKD independently predicted worse 1-year (OR 2.91) and 5-year (OR 3.08) mortality; moderate CKD predicted worse 5-year mortality (OR 2.66).
Conclusions:
- Moderate and severe CKD independently predict increased long-term mortality following major LEA.
- These findings suggest a potential causal link and emphasize the importance of early CKD recognition and preoperative optimization.
- Improved preoperative assessment and management of CKD patients undergoing LEA may enhance long-term outcomes.
Background:
Severe chronic kidney disease (CKD) predicts greater mortality after major lower-extremity amputation (LEA), but it remains poorly understood whether patients with earlier stages of CKD share similar risk.
Methods:
We assessed long-term postoperative outcomes for patients with CKD in a retrospective chart review of 565 patients who underwent atraumatic major LEA at a large tertiary referral center from 2015 to 2021. We stratified patients by renal function and compared outcomes including survival.
Results:
Preoperative CKD diagnosis was related to many patient characteristics, co-occurred with many comorbidities, and was associated with less follow-up and survival. Kaplan-Meier and Cox Regression analyses showed significantly worse 5-year survival for major LEA patients with mild, moderate, or severe CKD compared to major LEA patients with no history of CKD at the time of amputation (P < 0.001). Severe CKD independently predicted worse mortality at 1-year (odds ratio [OR] 2.91; P = 0.003) and 5-years (OR 3.08; P < 0.001). Moderate CKD independently predicted worse 5-year mortality (OR 2.66; P = 0.029).
Conclusions:
This study demonstrates that moderate and severe CKD predict greater long-term mortality following major LEA when controlling for numerous potential confounders. This finding raises questions about the underlying mechanism if causal and highlights an opportunity to improve outcomes with earlier recognition and optimization CKD preoperatively.
Related Concept Videos
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...