Clinical outcomes of patients with and without chronic kidney disease undergoing endovascular revascularization of infrainguinal peripheral artery disease: Insights from the XLPAD registry

Abstract

Objectives The purpose of the present study was to define clinical outcomes of chronic kidney disease (CKD) patients undergoing endovascular revascularization of infrainguinal peripheral artery disease (PAD). Background CKD is an established predictor of advanced PAD. However, clinical outcomes for these patients following endovascular revascularization remain inadequately defined. Methods Using the ongoing multicenter Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851), we analyzed all‐cause death, target limb amputation, and need for repeat revascularization for patients with and without CKD undergoing infrainguinal endovascular revascularization between the years 2005 and 2018. Results Of 3,699 patients, 15.1% (n = 559) had baseline CKD. CKD patients had significantly higher incidence of heavily calcified lesions (48.4% vs. 38.1%, p < .001) and diffuse disease (66.9% vs. 61.5%, p = .007). Kaplan–Meier analysis showed significant differences between CKD and non‐CKD patient outcomes at 12 months for freedom from target limb amputation (79.9% vs. 92.7%, p < .001) and all‐cause death (90.1% vs. 97.6%, p < .001). However, freedom from target vessel revascularization was similar between the groups. After adjusting for baseline comorbidities in the CKD and non‐CKD groups, the hazard ratios for target limb amputation and death at 12 months were 2.28 (95% confidence interval or CI 1.25–4.17, p < .001) and 4.38 (95% CI 2.58–7.45, p < .001), respectively. Conclusions Following endovascular revascularization for infrainguinal PAD, CKD was an independent predictor of all‐cause death and target limb amputation at 12 months.

The effect of chronic kidney disease on tissue formation of in situ tissue-engineered vascular grafts

“…Patients with chronic kidney disease (CKD) and/or cardiovascular disease (CVD) regularly require vascular grafts to bypass or replace diseased blood vessels. 1,2 Moreover, patients with CKD undergoing hemodialysis need vascular grafts to create vascular access for hemodialysis. 3 Autologous veins are generally preferred as a source of vascular graft material due to high long-term patency and low risk of infection, but are often unavailable because of preexisting vascular pathology 4 or show insufficient maturation.…”

It is all about the beans: How chronic kidney disease can affect outcomes in peripheral intervention

“…In this issue of Catheterization and Cardiovascular Interventions , Kabir et al 3 report clinical outcomes of patients with and without CKD undergoing infrainguinal endovascular revascularization from the multicenter XLPAD registry, which included 3699 patients from 2005 to 2018. Patient's with CKD had a higher incidence of hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, prior stroke, and heart failure.…”