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Impact of Hemodialysis on the Natural Course of Patients with Peripheral Arterial Occlusive Disease: A Propensity

Hyunwook Kwon1, Iksoo Shin1, Chung Hee Baek2

  • 1Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

Annals of Vascular Surgery
|April 3, 2026
PubMed

Insights

Patients with peripheral arterial occlusive disease (PAOD) on hemodialysis (HD) face significantly higher risks of lower limb amputation and death. Hemodialysis is a major risk factor for these adverse outcomes in PAOD patients without vascular interventions.

Area of Science:

  • Vascular Surgery
  • Nephrology
  • Cardiovascular Research

Background:

  • Peripheral arterial occlusive disease (PAOD) significantly impacts patient outcomes.
  • Hemodialysis (HD) is a common treatment for end-stage renal disease, often co-existing with PAOD.
  • The long-term natural course of PAOD in patients undergoing HD, particularly those without vascular interventions, requires further elucidation.

Purpose of the Study:

  • To compare long-term outcomes of patients with PAOD stratified by hemodialysis (HD) status.
  • To clarify the long-term impact of HD on the natural course of PAOD in patients who have not undergone vascular interventions.

Main Methods:

  • A retrospective study included 2733 adult patients with PAOD without vascular interventions from January 1995 to August 2020.
  • Patients were divided into non-HD (n=2516) and HD (n=217) groups.
  • Outcomes assessed were lower limb amputations and all-cause mortality, with propensity score (PS)-matched analysis performed.

Main Results:

  • The HD group was younger and had a higher prevalence of atherosclerosis.
  • Significantly higher rates of lower limb amputation (22.6% vs. 3.5%) and all-cause mortality (28.6% vs. 7.1%) were observed in the HD group compared to the non-HD group (P<0.001 for both).
  • PS-matched analysis confirmed significantly higher amputation and mortality rates in the HD group (P<0.001), though major amputation rates did not differ significantly (P=0.63).

Conclusions:

  • Patients with PAOD undergoing HD without vascular interventions face a substantially greater risk of long-term lower limb amputation and mortality.
  • Hemodialysis is identified as a significant independent risk factor for increased lower limb amputation and mortality rates in this patient population.
Abstract

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