Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease

IF 1.7 Q3 UROLOGY & NEPHROLOGY
Qingzheng Chen, Jialin Han, Gomathy Parvathinathan, E. Ross, Margaret R. Stedman, Tara I. Chang
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Abstract

Introduction. Patients with chronic kidney disease (CKD) have a high prevalence of peripheral artery disease. How best to manage lower extremity peripheral artery disease remains unclear in this patient population. We therefore sought to compare the outcomes after endovascular versus surgical lower extremity revascularization among patients with CKD. Methods. We used data from Optum’s de-identifed Clinformatics® Data Mart Database, a nationwide database of commercially insured persons in the United States to study patients with CKD who underwent lower extremity endovascular or surgical revascularization. We used inverse probability of treatment weighting to balance covariates. We employed proportional hazard regression to study the primary outcome of major adverse limb events (MALE), defined as a repeat revascularization or amputation. We also studied each of these events separately and death from any cause. Results. In our cohort, 60,057 patients underwent endovascular revascularization and 9,338 patients underwent surgical revascularization. Endovascular revascularization compared with surgical revascularization was associated with a higher adjusted hazard of MALE (hazard ratio (HR) 1.52; 95% confidence interval (CI) 1.46–1.59). Endovascular revascularization was also associated with a higher adjusted hazard of repeat revascularization (HR 1.65; 95% CI 1.57–1.72) but a lower adjusted risk of amputation (HR 0.71; CI 0.73–0.89). Patients undergoing endovascular revascularization also had a lower adjusted hazard for death from any cause (0.85; CI 0.82–0.88). Conclusions. In this analysis of patients with CKD undergoing lower extremity revascularization, an endovascular approach was associated with a higher rate of repeated revascularization but a lower risk of subsequent amputation and death compared with surgical revascularization. Multiple factors must be considered when counseling patients with CKD, who have a high burden of comorbid conditions. Clinical trials should include more patients with kidney disease, who are often otherwise excluded from participation, to better understand the most effective treatment strategies for this vulnerable patient population.
慢性肾病患者下肢血管重建的血管内治疗与外科治疗对比
简介慢性肾脏病(CKD)患者的外周动脉疾病发病率很高。对于这类患者,如何更好地治疗下肢外周动脉疾病仍不清楚。因此,我们试图比较 CKD 患者接受血管内和外科下肢血运重建术后的疗效。方法。我们使用 Optum 的去标识化 Clinformatics® Data Mart 数据库中的数据对接受下肢血管内或外科血管再通手术的 CKD 患者进行了研究。我们使用治疗反概率加权法来平衡协变量。我们采用比例危险回归法研究了肢体主要不良事件(MALE)这一主要结局,其定义为重复血管再通或截肢。我们还分别研究了这些事件以及任何原因导致的死亡。研究结果在我们的队列中,60,057 名患者接受了血管内血运重建,9,338 名患者接受了外科血运重建。血管内血运重建与手术血运重建相比,调整后的MALE风险更高(风险比(HR)1.52;95% 置信区间(CI)1.46-1.59)。血管内血运重建还与较高的重复血管内血运重建调整后风险(HR 1.65;95% CI 1.57-1.72)相关,但截肢调整后风险较低(HR 0.71;CI 0.73-0.89)。接受血管内再通术的患者因任何原因死亡的调整后风险也较低(0.85;CI 0.82-0.88)。结论在这项对接受下肢血管再通手术的慢性肾脏病患者进行的分析中,与外科血管再通手术相比,血管内治疗与较高的重复血管再通率相关,但随后截肢和死亡的风险较低。慢性肾脏病患者合并症较多,在为他们提供咨询时必须考虑多种因素。临床试验应纳入更多肾病患者,以便更好地了解针对这一弱势患者群体的最有效治疗策略。
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来源期刊
International Journal of Nephrology
International Journal of Nephrology UROLOGY & NEPHROLOGY-
CiteScore
3.40
自引率
4.80%
发文量
44
审稿时长
17 weeks
期刊介绍: International Journal of Nephrology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies focusing on the prevention, diagnosis, and management of kidney diseases and associated disorders. The journal welcomes submissions related to cell biology, developmental biology, genetics, immunology, pathology, pathophysiology of renal disease and progression, clinical nephrology, dialysis, and transplantation.
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