Association of chronic kidney disease with major cardiovascular outcomes following lower extremity endovascular revascularization.

Abstract

Objective: Chronic kidney disease (CKD) amplifies cardiovascular risk, yet its stage-specific influence on perioperative outcomes following endovascular lower extremity revascularization (LER) for peripheral artery disease (PAD) remains poorly characterized.

Methods: We conducted a retrospective cohort study using the ACS NSQIP registry (2013-2022). Adults undergoing endovascular LER for PAD were stratified by preoperative estimated glomerular filtration rate (eGFR) via the CKD-EPI 2021 equation: G1 (≥90), G2 (60-89), G3 (30-59), G4 (15-29), and G5 (<15 mL/min/1.73 m2 or dialysis dependent). The primary outcome was 30-day major adverse cardiovascular events (MACE: myocardial infarction, stroke, or death). Multivariable logistic regression estimated adjusted odds ratios (OR) with 95% confidence intervals (CI).

Results: Among 22,424 patients (64.6% aged ≥65 years; 36.1% women), comorbidity burden increased progressively with CKD stage. Within 30 days, 556 patients (2.5%) experienced MACE. Event rates rose stepwise: 1.5% (G1), 1.6% (G2), 2.7% (G3), 4.9% (G4), and 6.0% (G5). After adjustment for age, sex, race/ethnicity, ASA class, admission status, presenting symptoms, and preoperative hematocrit, advanced CKD remained independently associated with MACE: OR 2.30 (95% CI 1.50-3.52) for G4 and OR 3.15 (95% CI 2.28-4.35) for G5 versus G1.

Conclusion: CKD stage provides independent prognostic information in patients undergoing endovascular LER. Advanced CKD independently predicts 30-day MACE with a dose-response relationship across stages. Preoperative eGFR should be incorporated into perioperative risk stratification protocols to guide cardiovascular optimization and surveillance planning.