Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease
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...
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | International Journal of Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2023/5586060 |
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| author | Qingzheng Chen Jialin Han Gomathy Parvathinathan Elsie Ross Margaret R. Stedman Tara I. Chang |
| author_facet | Qingzheng Chen Jialin Han Gomathy Parvathinathan Elsie Ross Margaret R. Stedman Tara I. Chang |
| author_sort | Qingzheng Chen |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-541df95cdc0c4bba8b2054090aeef271 |
| institution | Kabale University |
| issn | 2090-2158 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Nephrology |
| spelling | doaj-art-541df95cdc0c4bba8b2054090aeef2712025-02-03T06:42:55ZengWileyInternational Journal of Nephrology2090-21582023-01-01202310.1155/2023/5586060Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney DiseaseQingzheng Chen0Jialin Han1Gomathy Parvathinathan2Elsie Ross3Margaret R. Stedman4Tara I. Chang5Stanford UniversityStanford UniversityStanford UniversityStanford UniversityStanford UniversityStanford UniversityIntroduction. 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.http://dx.doi.org/10.1155/2023/5586060 |
| spellingShingle | Qingzheng Chen Jialin Han Gomathy Parvathinathan Elsie Ross Margaret R. Stedman Tara I. Chang Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease International Journal of Nephrology |
| title | Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease |
| title_full | Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease |
| title_fullStr | Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease |
| title_full_unstemmed | Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease |
| title_short | Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease |
| title_sort | endovascular versus surgical lower extremity revascularization among patients with chronic kidney disease |
| url | http://dx.doi.org/10.1155/2023/5586060 |
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