Predictors of amputation and survival following lower extremity revascularization in hemodialysis patients

Abstract

Risk of amputation following revascularization procedures was positively associated with type of procedure, black race, uninsured/Medicaid, and diabetes status. Risk of death was also higher following bypass. While this might reflect underlying severity of disease, patient education, screening, and optimal care of lower extremities should be emphasized to detect PVD at an early stage of the disease process.

Renal Insufficiency and Use of Revascularization among a National Cohort of Men with Advanced Lower Extremity Peripheral Arterial Disease

“…This study thus also underlines the need for more detailed studies of this patient group to understand better why they are not referred for surgery and how they are treated. Consistent with previous studies in dialysis patients (5,14,20), our study demonstrates that patients who have advanced renal insufficiency and undergo revascularization for critical limb ischemia are at risk for requiring a subsequent major amputation. Unfortunately, our data do not indicate whether subsequent amputations occurred in the same or opposite leg as the revascularization procedure.…”

Epidemiology of Chronic Kidney Disease

“…As discussed in chapter 2, the classification of CKD using the NKF stages provides substantial prognostic and diagnostic information concerning 1) outcomes (progression to ESRD and mortality) [18,19] and 2) ocurrence of intercurrent morbidity (ischemic heart disease, stroke, and peripheral vascular disease) [20][21][22][23][24][25][26][27][28]. Further, the stage of CKD is predictive of the prevalence of complications associated with impaired kidney function (anemia, bone disease, and nutritional and functional status) ( Table 1.2).…”

The Diabetic Foot in End Stage Renal Disease

“…[62] Nonetheless, the direct effect of hemodialysis should not lead to an underestimation of perturbations associated with diabetes. [63,64] Among patients with various kidney diseases requiring dialysis, diabetes significantly increases the risk for amputation by 2.51-6.4. [63,64] Intradialytic or post-dialysis hypotension may generally elicit a hemodynamic response with reduced peripheral blood flow to preserve central circulation, but these changes are extremely crucial in diabetic patients with distal peripheral vasculopathy and cardiac autonomic neuropathy.…”

“…[63,64] Among patients with various kidney diseases requiring dialysis, diabetes significantly increases the risk for amputation by 2.51-6.4. [63,64] Intradialytic or post-dialysis hypotension may generally elicit a hemodynamic response with reduced peripheral blood flow to preserve central circulation, but these changes are extremely crucial in diabetic patients with distal peripheral vasculopathy and cardiac autonomic neuropathy. Indeed, a trend toward reduced transcutaneous oxygen pressure (TcPO 2 ) on the dorsum of the foot, reflecting poor circulation, for at least four hours after dialysis has been shown in patients with diabetes.…”