The impact of chronic kidney disease on outcomes following peripheral vascular intervention

Dennis I Narcisse, Elizabeth Hope Weissler, Jennifer A Rymer, Ehrin J Armstrong, Eric A Secemsky, William A Gray, Jihad A Mustapha, George L Adams, Gary M Ansel, Manesh R Patel, William Schuyler Jones, Dennis I Narcisse, Elizabeth Hope Weissler, Jennifer A Rymer, Ehrin J Armstrong, Eric A Secemsky, William A Gray, Jihad A Mustapha, George L Adams, Gary M Ansel, Manesh R Patel, William Schuyler Jones

Abstract

Background: Patients with chronic kidney disease (CKD) have worsened clinical outcomes following percutaneous coronary intervention; however, limited evidence exists in patients undergoing peripheral vascular intervention (PVI).

Purpose: We aimed to assess the effect of CKD on outcomes following PVI for symptomatic peripheral artery disease.

Methods: Using patients from the LIBERTY 360 study, we compared the rates of 30 day and 1 year major adverse vascular events (MAVE), a composite of all-cause mortality, major amputation, and target vessel/lesion revascularization, between patients with and without CKD (estimated glomular filtration rate less than 60) following PVI. Multivariable adjustment was performed to assess for independent association between CKD and outcomes.

Results: Among 1189 patients enrolled, 378 patients (31.8%) had CKD. At 1 year, patients with CKD had higher rates of MAVE (34.6% vs 25.6%), all-cause mortality (11.9% vs 5.5%), and major amputation (5.9% vs 2.6%) when compared with patients without CKD (all P < .05). After adjustment, patients with CKD had higher risks of 1-year MAVE (HR 1.30, 95% CI 1.04-1.64; P = .023) and all-cause mortality (HR 1.88, 95% CI 1.22-2.91; P = .005) when compared with patients without CKD. There was no statistically significant difference in risk of major amputations (HR 1.70, 95% CI 0.91-3.17; P = .094).

Conclusions: Despite high procedural success and low amputation rates, patients with CKD remain at greater risk for MAVE and all-cause mortality after PVI. Further research is needed to determine treatment strategies to mitigate substantial mortality risk in this vulnerable population.

Keywords: chronic kidney disease; mortality; peripheral artery disease; revasculariation.

Conflict of interest statement

D. I. N., E. H. W.: They declare no potetntial conflict of interest. J. A. R.: Salary support from the American College of Cardiology. Research support from Boston Scientific and Abbott. E. J. A.: Consultant/Advisory Board: Abbott Vascular, Boston Scientific, Cardiovascular Systems, Gore, Intact Vascular, Medtronic, Philips. E. A. S.: Research grants to BIDMC: AstraZeneca, BD Bard, Boston Scientific, Cook Medical, CSI, Medtronic, Philips, and UCSF. Consulting: BD Bard, CSI, Medtronic, and Philips. Speaking Bureau: BD Bard, Cook Medical and Medtronic. W. A. G.: Research support: Boston Scientific, Medtronic, Surmodics, Gore, Intact Vascular, Philips. J. A. M.: Consultant to BD, Boston Scientific, Cardiovascular Systems, Inc., Medtronic, Philips, and Terumo. G. L. A.: Research support: Cardiovascular Systems, Inc., Bostom Scientific, Medtronic, Abbott Vascular, Philips, Gore, Cook Medical, BD Bard. Consulting: Cardiovascular Systems, Inc., Bostom Scientific, Medtronic, Abbott Vascular, Philips, Gore, Cook Medical, BD Bard. G. M. A.: Consulting: Cardiovascular Systems, Inc., Medtronic, Boston Scientific, Phillips, Surmodics. Royalties: Cook Medical. M. R. P.: Research grants from AHRQ, AstraZeneca, Bayer, Jansen, Procyrion, Heartflow; Honoraria/advisory board for Bayer, Janssen, AstraZeneca. W. S. J.: Research grants from Agency for Healthcare Research and Quality, AstraZeneca, American Heart Association, Bristol‐Myers Squibb, Doris Duke Charitable Foundation, Patient‐Centered Outcomes Research Institute; Honorarium/other from American College of Radiology, Daiichi Sankyo.

© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
Ascertainment of the study population. CKD, patients with chronic kidney disease; PAD, peripheral artery disease; PVI, peripheral vascular intervention; RC, Rutherford classification
FIGURE 2
FIGURE 2
Kaplan–Meier curves comparing major Adverse vascular events, all‐cause mortality, major amputation, and target vessel/lesion revascularization in patients with and without chronic kidney disease. Kaplan Meier curves are shown for A, MAVE; B, all‐cause mortality; C, major amputation; and D, target vessel/lesion revascularization in patients with and without CKD. Event rates of each outcome for patients with CKD compared with patients without CKD at 1 year after PVI. CKD, chronica kidney disease; MAVE, major adverse vascular events; PVI, peripheral vascular intervention

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