Peripheral Vascular Disease–Related Procedures in Dialysis Patients

Abstract

Background and objectives: Peripheral vascular disease (PVD) is prevalent among dialysis patients, and many dialysis patients undergo PVD-related procedures. We aimed to examine the risk factors for and prognosis after such procedures in the dialysis setting.Design, setting, participants, & measurements: In a national prospective cohort study of 1041 incident dialysis patients, we examined the factors that are associated with PVD procedures (lower extremity amputations and bypasses) after the start of dialysis. Adjusted risk for PVD procedures of various factors was estimated using multivariable Cox proportional hazards models. Incidence rates of subsequent cardiovascular events, infectious hospitalizations, PVD-and cardiovascular diseaserelated mortality, and all-cause mortality were compared for those with and without a PVD procedure.Results: Overall, 217 (21%) patients underwent a PVD procedure after the start of dialysis. For those without diabetes, only PVD history (relative hazard [RH] 2.9; 95% confidence interval [CI] 1.3 to 6.6) and increased fibrinogen (RH 1.2; 95% CI 1.0 to 1.5) predicted PVD procedures. For those with diabetes, increased serum phosphate (RH 1.2; 95% CI 1.1 to 1.4), along with decreased albumin, increased C-reactive protein and fibrinogen, and lower SBP, was associated with risk for PVD procedures. Of those who had a procedure compared with those who did not, 68 versus 30% experienced a subsequent cardiovascular event, 85 versus 66% an infectious hospitalization, 11 versus 2% a PVD-related death, and 81 versus 59% all-cause death (mean follow-up 3.0 yr).Conclusions: Prognosis after PVD procedures is poor, and providers should be aware that risk factors for PVD procedures may differ by diabetes status.

Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective

“…44 As previously discussed that DM predisposes to micro-and macro-vascular complications, development of diabetic foot syndrome and also infections, 2,3 it would be ideal for these patients to have a tighter control of their blood sugar levels hence preventing worsening prognosis of foot complications which require LLAs. Our findings are consistent with other studies done previously; Plantinga et al 21 and Ishii et al 16 also found the association between high CRP levels while Plantinga et al's study along with Speckman et al 24 also reported the low levels of albumin amongst amputees, while LockingCustolito et al 17 found that elevated HbA1c was associated with LLAs. Our study was a retrospective chart audit and we were relying on the health professional's accuracy of information documented in patient medical records as well as biochemical pathology data base for our data collection.…”

“…This could be true in the case of our study as all the subjects with LLA had concurrent DM which is strongly associated with foot ulceration. 12,25 On the other hand, the strong association between PAD and LLAs in the current study was reported by others 21 where calciphylaxis was thought to be a contributing factor. 15 Other risk factors for LLA identified in this study include peripheral neuropathy and retinopathy as previously reported.…”

“…High prevalence of non-traumatic LLA was observed in this study where 13.3% of these patients had LLA. This prevalence is similar and comparable to that in the United States and Canada 17,21,22 however, is much higher than other parts of the world, such as Japan. 16 A closer look at our data revealed that half of the patients attending to the dialysis center were from an aboriginal heritage; however as per the 2011 census only 6.13% of the population of Townsville region is represented by people with an indigenous background.…”

“…Locking-Custolito et al, Combe et al, Plantinga et al and Ishii and colleagues, also found positive association between presence of DM and LLAs. [15][16][17]21 The strongest association with LLAs, that our study found, was that of history of ulceration. In contrast, previous studies do not associate this as the strongest risk factor.…”

Peripheral Arterial Disease Predicts Overall and Cardiovascular Mortality in Peritoneal Dialysis Patients

“…7,8 Limited available data also suggest that PAD is prevalent in hemodialysis patients 4,[9][10][11][12] and is associated with poor outcomes. 4,6,13 However, the studies on the role of PAD in predicting mortality in peritoneal dialysis patients are even less. [14][15][16] Liu et al 17 recently reported that the prevalence of PAD is high and is associated with total mortality in 153 Taiwan Peritoneal Dialysis (PD) patients; however, the patients with PAD were much older than non-PAD peers (64.3 years vs. 52.1 years, p < 0.001).…”