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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Outcomes of Patients with Critical Limb Ischemia and Chronic Kidney Disease: A National Perspective
Frederick Berro Rivera1, John Paul Aparece2, Jade Monica Marie Ruyeras3
1Department of Medicine, Lincoln Medical Center, New York, New York, USA, frederick.berro.rivera@gmail.com.
Insights
Patients with chronic kidney disease (CKD) admitted for peripheral arterial disease with critical limb ischemia (PAD-CLI) face higher mortality and amputation rates. They also receive less revascularization compared to those without CKD.
Area of Science:
- Vascular Medicine
- Nephrology
- In-hospital Outcomes Research
Background:
- Limited studies explore outcomes for patients with peripheral arterial disease (PAD) and critical limb ischemia (CLI) who also have chronic kidney disease (CKD).
- Understanding the impact of CKD on in-hospital outcomes for PAD-CLI patients is crucial for improving care.
Purpose of the Study:
- To analyze the in-hospital outcomes of patients admitted for PAD-CLI with concomitant CKD.
- To compare mortality, complications, and treatment patterns between PAD-CLI patients with and without CKD.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2012-2020.
- Identified hospitalizations for CLI and cases with concurrent CKD.
- Employed multivariable logistic regression to assess outcomes including mortality, vascular complications, bleeding, and amputation rates.
Main Results:
- Of 441,245 CLI patients, 27.7% had CKD.
- CKD patients exhibited higher in-hospital mortality (OR 1.68), vascular complications (OR 1.31), acute kidney injury requiring hemodialysis (OR 3.17), and major bleeding (OR 1.12).
- CKD patients underwent revascularization less frequently but had higher rates of major and minor amputations.
Conclusions:
- Concomitant CKD significantly increases in-hospital mortality for patients with PAD-CLI.
- CKD patients with PAD-CLI are less likely to receive revascularization procedures and more prone to amputation.
- These findings highlight the complex interplay between CKD and PAD-CLI, necessitating tailored management strategies.
Introduction:
Studies exploring the relationship between peripheral arterial disease (PAD), critical limb ischemia (CLI), and chronic kidney disease (CKD) and its effect on in-hospital outcomes are limited. We aimed to analyze the outcomes of patients with CKD and PAD who are admitted for CLI.
Methods:
We utilized the National Inpatient Sample (NIS) to capture hospitalizations for CLI from 2012 to 2020 and then identified cases with concomitant CKD. The primary outcome was mortality, and secondary outcomes were cerebrovascular accident, major bleeding, vasopressor requirement, percutaneous coronary intervention, cardiac arrest, acute respiratory failure, transfusion, length of stay, and total hospital charges. Multivariable logistic regression was performed to adjust for covariates.
Results:
A total of 441,245 patients with CLI were identified, of which 122,370 (27.7%) reported concomitant CKD. Patients with CKD had higher in-patient mortality (odds ratio [OR] 1.68, 95% confidence interval [CI], 1.17-1.68, p < 0.001), vascular complications (OR 1.31, 95% CI, 1.17-1.48, p < 0.001), acute kidney injury requiring hemodialysis (OR 3.17, 95% CI, 2.64-3.80, p < 0.001), and major bleeding (OR 1.12, 95% CI, 1.05-1.19, p < 0.001). Patients with CKD underwent minimally invasive endovascular therapy (31.08% vs. 36.73%, p < 0.0001) and invasive procedures (14.73% vs. 23.55%, p < 0.0001) less often. PAD-CLI with CKD was associated with major (20.54% vs. 16.17%, OR 1.04; p < 0.0001) and minor (26.87% vs. 19.53%, OR 1.2, p < 0.0001) amputations more often.
Conclusion:
Patients admitted for PAD-CLI with concomitant CKD have significantly higher in-hospital mortality as compared to patients without CKD. Moreover, patients with CKD and PAD-CLI are less likely to receive revascularization and more likely to undergo amputation.
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