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Rivera FB, Aparece JP, Marie Ruyeras JM, Menghrajani RH, Ybañez MJ, Candida Honorio EG, Albert Ramirez Damayo JI, Li G, Dwivedi A, Puentespina RA, Talili PJ, Cu JP, Alfonso Marañon Joson JJ, Baoy Bantayan NR, Lerma EV, Collado FM, Ong K, Vijayaraghavan K, Kazory A. Outcomes of Patients with Critical Limb Ischemia and Chronic Kidney Disease: A National Perspective. Cardiorenal Med 2024; 14:533-542. [PMID: 39222616 DOI: 10.1159/000541146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Studies exploring the relationship between peripheral arterial disease (PAD), critical limb ischemia (CLI), and chronic kidney disease (CKD) and its effect on in-hospital outcomes are limited. We aimed to analyze the outcomes of patients with CKD and PAD who are admitted for CLI. METHODS We utilized the National Inpatient Sample (NIS) to capture hospitalizations for CLI from 2012 to 2020 and then identified cases with concomitant CKD. The primary outcome was mortality, and secondary outcomes were cerebrovascular accident, major bleeding, vasopressor requirement, percutaneous coronary intervention, cardiac arrest, acute respiratory failure, transfusion, length of stay, and total hospital charges. Multivariable logistic regression was performed to adjust for covariates. RESULTS A total of 441,245 patients with CLI were identified, of which 122,370 (27.7%) reported concomitant CKD. Patients with CKD had higher in-patient mortality (odds ratio [OR] 1.68, 95% confidence interval [CI], 1.17-1.68, p < 0.001), vascular complications (OR 1.31, 95% CI, 1.17-1.48, p < 0.001), acute kidney injury requiring hemodialysis (OR 3.17, 95% CI, 2.64-3.80, p < 0.001), and major bleeding (OR 1.12, 95% CI, 1.05-1.19, p < 0.001). Patients with CKD underwent minimally invasive endovascular therapy (31.08% vs. 36.73%, p < 0.0001) and invasive procedures (14.73% vs. 23.55%, p < 0.0001) less often. PAD-CLI with CKD was associated with major (20.54% vs. 16.17%, OR 1.04; p < 0.0001) and minor (26.87% vs. 19.53%, OR 1.2, p < 0.0001) amputations more often. CONCLUSION Patients admitted for PAD-CLI with concomitant CKD have significantly higher in-hospital mortality as compared to patients without CKD. Moreover, patients with CKD and PAD-CLI are less likely to receive revascularization and more likely to undergo amputation.
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Affiliation(s)
| | - John Paul Aparece
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | | | | | | | | | | | - Guowei Li
- Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alok Dwivedi
- Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | | | | | - Joanna Pauline Cu
- Department of Medicine, Philippine General Hospital, Manila, Philippines
| | | | | | - Edgar V Lerma
- Section of Nephrology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | | | - Kenneth Ong
- Department of Cardiology, Lincoln Medical Center, New York, New York, USA
| | | | - Amir Kazory
- Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida, USA
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Umekawa K, Kurabayashi T, Asato H, Iida T, Suzuki A, Tasaki M. A Free Bypass Flap for Chronic Limb-threatening Ischemia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5875. [PMID: 38859803 PMCID: PMC11164000 DOI: 10.1097/gox.0000000000005875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/08/2024] [Indexed: 06/12/2024]
Abstract
Background Recently, significant inframalleolar disease seems to increase in chronic limb-threatening ischemia (CLTI) patients, making identifying sufficient outflow vessels in the foot challenging. In these difficult situations, free tissue transfer is a valuable tool to provide a low-resistance vascular bed to the affected part. However, there remains concern that free tissue transfer may impede adequate perfusion of the higher resistance diseased vascular bed. Methods To improve perfusion of the affected area directly, the authors have developed a concept of a free bypass flap, adding bypass surgery to free tissue transfer. After anastomosis with the recipient vessels in a conventional manner for free tissue transfer, bypass surgery to the foot is performed by anastomosis of the branch of the flap pedicle with the diseased artery to the foot. A retrospective chart review of nine CLTI patients was performed to analyze the outcomes of free bypass flap transfer between 2018 and 2023. Results The flap success rate was 100% (n = 9). Postoperative angiography or echo confirmed the patency of all but one bypass vessel (n = 8). There were six fatalities, however, due to causes other than foot lesions, with an average observation period of 16 months. The limb salvage rate was 89% (n = 8). Conclusions A free bypass flap enhances the overall blood circulation to the foot. Due to its high patency rate of bypass vessels, it is a valuable method for preserving the limbs of highly comorbid patients with CLTI.
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Affiliation(s)
- Kohei Umekawa
- From the Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Takashi Kurabayashi
- From the Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hirotaka Asato
- From the Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Takuya Iida
- From the Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Ayako Suzuki
- From the Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Masanori Tasaki
- From the Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
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Mehta H, Chan WC, Aday AW, Jones WS, Parmar GM, Hance K, Thors A, Alli A, Wiley M, Tadros P, Gupta K. Outcomes of peripheral artery disease and polyvascular disease in patients with end-stage kidney disease. J Vasc Surg 2024; 79:1170-1178.e10. [PMID: 38244643 DOI: 10.1016/j.jvs.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE Patients with peripheral artery disease (PAD) and end-stage kidney disease are a high-risk population, and concomitant atherosclerosis in coronary arteries (CAD) or cerebral arteries (CVD) is common. The aim of the study was to assess long-term outcomes of PAD and the impact of coexistent CAD and CVD on outcomes. METHODS The United States Renal Data System was used to identify patients with PAD within 6 months of incident dialysis. Four groups were formed: PAD alone, PAD with CAD, PAD with CVD, and PAD with CAD and CVD. PAD-specific outcomes (chronic limb-threatening ischemia, major amputation, percutaneous/surgical revascularization, and their composite, defined as major adverse limb events [MALE]) as well as all-cause mortality, myocardial infarction, and stroke were studied. RESULTS The study included 106,567 patients (mean age, 71.2 years; 40.8% female) with a median follow-up of 546 days (interquartile range, 214-1096 days). Most patients had PAD and CAD (49.8%), 25.8% had PAD alone, and 19.2% had all three territories involved. MALE rate in patients with PAD was 22.3% and 35.0% at 1 and 3 years, respectively. In comparison to PAD alone, the coexistence of both CAD and CVD (ie, polyvascular disease) was associated with a higher adjusted rates of all-cause mortality (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.24-1.31), myocardial infarction (HR, 1.78; 95% CI, 1.69-1.88), stroke (HR, 1.66; 95% CI, 1.52,1.80), and MALE (HR, 1.07; 95% CI, 1.04-1.11). CONCLUSIONS Patients with end-stage kidney disease have a high burden of PAD with poor long-term outcomes, which worsen, in an incremental fashion, with the involvement of each additional diseased arterial bed.
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Affiliation(s)
- Harsh Mehta
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Wan-Chi Chan
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Aaron W Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - W Schuyler Jones
- Department of Medicine, Duke University Health System, Durham, NC
| | - Gaurav M Parmar
- Section of Vascular Medicine, Massachusetts General Hospital, Boston, MA
| | - Kirk Hance
- Department of Surgery, University of Kansas School of Medicine, Kansas City, KS
| | - Axel Thors
- Department of Surgery, University of Kansas School of Medicine, Kansas City, KS
| | - Adam Alli
- Department of Radiology, University of Kansas School of Medicine, Kansas City, KS
| | - Mark Wiley
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Peter Tadros
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS.
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Kirkham AM, Candeliere J, Mai T, Nagpal SK, Brandys TM, Dubois L, Shorr R, Stelfox HT, McIsaac DI, Roberts DJ. Risk Factors for Surgical Site Infection after Lower Limb Revascularisation Surgery: a Systematic Review and Meta-Analysis of Prognostic Studies. Eur J Vasc Endovasc Surg 2024; 67:455-467. [PMID: 37925099 DOI: 10.1016/j.ejvs.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To systematically review and meta-analyse adjusted risk factors for surgical site infection (SSI) after lower limb revascularisation surgery. DATA SOURCES MEDLINE, Embase, Evidence Based Medicine Reviews, and the Cochrane Central Register of Controlled Trials (inception to 28 April 2022). REVIEW METHODS Systematic review and meta-analysis conducted according to PRISMA guidelines. After protocol registration, databases were searched. Studies reporting adjusted risk factors for SSI in adults who underwent lower limb revascularisation surgery for peripheral artery disease were included. Adjusted odds ratios (ORs) were pooled using random effects models. GRADE was used to assess certainty. RESULTS Among 6 377 citations identified, 50 studies (n = 271 125 patients) were included. The cumulative incidence of SSI was 12 (95% confidence interval [CI] 10 - 13) per 100 patients. Studies reported 139 potential SSI risk factors adjusted for a median of 12 (range 1 - 69) potential confounding factors. Risk factors that increased the pooled adjusted odds of SSI included: female sex (pooled OR 1.41, 95% CI 1.20 - 1.64; high certainty); dependent functional status (pooled OR 1.18, 95% CI 1.03 - 1.35; low certainty); being overweight (pooled OR 1.82, 95% CI 1.29 - 2.56; moderate certainty), obese (pooled OR 2.20, 95% CI 1.44 - 3.36; high certainty), or morbidly obese (pooled OR 1.65, 95% CI 1.08 - 2.52; moderate certainty); chronic obstructive pulmonary disease (pooled OR 1.42, 95% CI 1.17 - 1.71; high certainty); chronic limb threatening ischaemia (pooled OR 1.67, 95% CI 1.22 - 2.29; moderate certainty); chronic kidney disease (pooled OR 2.13, 95% CI 1.18 - 3.83; moderate certainty); intra-operative (pooled OR 1.23, 95% CI 1.02 - 1.49), peri-operative (pooled OR 1.92, 95% CI 1.27 - 2.90), or post-operative (pooled OR 2.21, 95% CI 1.44 - 3.39) blood transfusion (moderate certainty for all); urgent or emergency surgery (pooled OR 2.12, 95% CI 1.22 - 3.70; moderate certainty); vein bypass and or patch instead of endarterectomy alone (pooled OR 1.86, 95% CI 1.33 - 2.59; moderate certainty); an operation lasting ≥ 3 hours (pooled OR 1.86, 95% CI 1.33 - 2.59; moderate certainty) or ≥ 5 hours (pooled OR 1.60, 95% CI 1.18 - 2.17; moderate certainty); and early or unplanned re-operation (pooled OR 4.50, 95% CI 2.18 - 9.32; low certainty). CONCLUSION This systematic review identified evidence informed SSI risk factors following lower limb revascularisation surgery. These may be used to develop improved SSI risk prediction tools and to identify patients who may benefit from evidence informed SSI prevention strategies.
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Affiliation(s)
- Aidan M Kirkham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jasmine Candeliere
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Trinh Mai
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Sudhir K Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Timothy M Brandys
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Dubois
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Henry T Stelfox
- The O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Departments of Critical Care Medicine, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Daniel I McIsaac
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Derek J Roberts
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; The O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
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Adedokun SD, Sarwar M, Hwang K, Hans A, Baskaran J, Anantha Narayanan M. Outcomes of lower extremity peripheral arterial interventions in patients with and without chronic kidney disease or end-stage renal disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:624-633. [PMID: 38078709 DOI: 10.23736/s0021-9509.23.12798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Peripheral arterial disease (PAD) is a progressive vascular condition characterized by the narrowing or blockage of arteries, primarily attributed to atherosclerosis. PAD's prevalence in the general population is estimated at approximately 5.9%. Notably however, among patients with chronic kidney disease (CKD), PAD's prevalence is substantially higher, ranging from 17% to 48%. This review paper emphasizes the pervasiveness of PAD and its intricate relationship with CKD and end-stage renal disease (ESRD). It demonstrates the importance of early detection, proactive screening, and understanding the formidable challenges associated with treating heavily calcified lesions. EVIDENCE ACQUISITION Comprehensive literature searches encompassed the PubMed/MEDLINE, Cochrane Library, and Embase databases, in order to identify studies involving lower extremity peripheral arterial interventions in patients both with and without CKD or ESRD. The search spanned the timeframe from January 2001 to July 2023. The search strategy included vocabulary terms concerning peripheral artery disease, lower extremities, revascularization, chronic kidney disease, and end-stage renal disease. EVIDENCE SYNTHESIS Initial searches were used to identify articles based on title. Exclusion criteria was then applied, and any redundant articles were removed. The articles abstracts were then reviewed, and relevant articles were selected. Once selected the articles were thoroughly reviewed including the references to find other relevant articles that were missed during the initial search process. In total 28 articles were selected and included for review of clinical data in regard to PAD outcomes in patients with advanced kidney disease. CONCLUSIONS The findings highlight the need for personalized approaches in diagnosing and treating PAD in CKD and ESRD patients. Interdisciplinary collaboration, such as those between nephrologists, vascular surgeons, and interventional radiologists, is vital to optimize outcomes. Further research should focus on innovative, tailored interventions to enhance limb preservation, reduce mortality, prolong patency, and cut healthcare costs.
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Affiliation(s)
| | - Maruf Sarwar
- Section of Internal Medicine, White River Health, Batesville, AR, USA
| | - Keonmin Hwang
- HCA Tristar Skyline Medical Center, Nashville, TN, USA
| | - Aakash Hans
- Section of Internal Medicine, White River Health, Batesville, AR, USA
| | - Janani Baskaran
- Section of Internal Medicine, White River Health, Batesville, AR, USA
| | - Mahesh Anantha Narayanan
- Section of Cardiovascular Diseases, White River Health, Batesville, AR, USA -
- University of Arkansas Medical Sciences, Little Rock, AR, USA
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Ye M, Ni Q, Zhu Y, Du Y, Wang Y, Guo X, Zhang L, Feng Z. Stent Graft vs Drug-Coated Balloon in Endovascular Treatment of Complex Femoropopliteal Artery Lesions: A 2-Center Experience. J Endovasc Ther 2023:15266028231201097. [PMID: 37728023 DOI: 10.1177/15266028231201097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Both stent grafts (SG) and drug-coated balloons (DCBs) have shown to be effective treatments for long and complex femoropopliteal (FP) lesions. However, there has not been a clinical trial comparing the 2 treatments directly. This study aims to compare the primary patency (PP) and clinical outcomes of SG and DCB for endovascular treatment of complex FP Trans-Atlantic Inter-Society Consensus (TASC) C/D lesions in patients. METHODS From July 2013 to May 2019, a retrospective study was conducted at 2 medical centers to compare the clinical outcomes of Viabahn SG and DCB angioplasty in patients with TASC C/D FP lesions. The study used overlap weighting to adjust for differences in baseline characteristics and to reduce the impact of confounding factors and selection bias between the 2 groups. The primary endpoint was PP through 24 months, and the secondary endpoints included freedom from clinical-driven target lesion revascularization (CD-TLR), all-cause of death rate, and major amputation rate. RESULTS A total of 161 limbs in 150 patients with TASC C/D FP lesions were treated either with Viabahn SGs (67 limbs, 65 patients) or DCBs (94 limbs, 85 patients). In the DCB group, 22 target vessels (23.4%) underwent directional atherectomy before DCB angioplasty and 37 target vessels (39.4%) underwent bail-out bare-metal stent implantation for early recoil or severe dissection. The SG group had significantly higher PP rates at both the 12 and 24 months than in the DCB group (75.8% vs 39.2%, p=0.02; 64.1% vs 31.9%, p=0.02), respectively. However, there were no significant differences between the 2 groups in terms of CD-TLR, death rate, and major amputation rate. According to the results of multivariate analysis, DCB angioplasty was the only independent predictor associated with restenosis (hazard ratio [HR]=0.264, 95% confidence interval [CI]=0.100-0.696, p=0.007). CONCLUSIONS This study showed that SG was associated with a significantly higher PP rate in complex long FP lesions compared with DCB angioplasty. However, there was no significant difference in the freedom from CD-TLR and major amputation rate. It is important to follow the criteria for using SG strictly to avoid early restenosis, which can lead to acute thrombosis and severe limb ischemia. Closer monitoring is recommended for patients who undergo SG implantation. CLINICAL IMPACT There has no head-to-head clinical trial that compares DCB and SG in complex long FP lesions. This study showed that SG following the criteria was associated with a significantly higher PP rate compared with DCB angioplasty. Closer monitoring is recommended for patients with SG to avoid acute thrombosis. Randomized controlled trials comparing SG and DCB are necessary.
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Affiliation(s)
- Meng Ye
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qihong Ni
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Youpeng Zhu
- Department of Vascular Surgery, Liyuan Hospital Affiliated Tongji Medical Collage of Huazhong University of Science & Technology, Wuhan, China
| | - Ye Du
- Department of Vascular Surgery, Liyuan Hospital Affiliated Tongji Medical Collage of Huazhong University of Science & Technology, Wuhan, China
| | - Yuli Wang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiangjiang Guo
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lan Zhang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zibo Feng
- Department of Vascular Surgery, Liyuan Hospital Affiliated Tongji Medical Collage of Huazhong University of Science & Technology, Wuhan, China
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Liao YC, Chang CC, Chen CY, Liu CC, Liao CC, Shih YRV, Lin CS. Preoperative renal insufficiency predicts postoperative adverse outcomes in a mixed surgical population: a retrospective matched cohort study using the NSQIP database. Int J Surg 2023; 109:752-759. [PMID: 36974714 PMCID: PMC10389524 DOI: 10.1097/js9.0000000000000278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/27/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The incidence of chronic kidney disease is increasing, but most cases are not diagnosed until the accidental finding of abnormal laboratory data or the presentation of severe symptoms. Patients with chronic kidney disease are reported to have an increased risk of postoperative mortality and morbidities, but previous studies mainly targeted populations undergoing cardiovascular surgery. The authors aimed to evaluate the risk of postoperative mortality and complications in a surgical population with preoperative renal insufficiency (RI). MATERIALS AND METHODS This retrospective cohort study used data from the National Surgical Quality Improvement Program database between 2013 and 2018 to evaluate the risk of postoperative morbidity and mortality in the surgical population. Patients with estimated glomerular filtration rate less than 60 ml/min/1.73 m 2 were defined as the RI group. Propensity score matching methods and multivariate logistic regression were used to calculate the risk of postoperative morbidity and mortality. RESULTS After propensity score matching, 502 281 patients were included in the RI and non-RI groups. The RI group had a higher risk of 30-day in-hospital mortality (odds ratio: 1.54, 95% CI: 1.49-1.58) than the non-RI group. The RI group was associated with a higher risk of postoperative complications, including myocardial infarction, stroke, pneumonia, septic shock, and postoperative bleeding. The RI group was also associated with an increased risk of prolonged ventilator use for over 48 h, readmission, and reoperation. CONCLUSION Patients with preoperative RI have an increased risk of postoperative 30-day mortality and complications. RI group patients with current dialysis, estimated glomerular filtration rate less than or equal to 30 ml/min/1.73 m 2 or concomitant anemia had an elevated risk of postoperative mortality.
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Affiliation(s)
| | - Chuen-Chau Chang
- Department of Anesthesiology
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Anesthesiology
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chung Liu
- Department of Anesthesiology
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ru Vernon Shih
- Department of Orthopedic Surgery, Duke University, Durham, North Carolina, USA
| | - Chao-Shun Lin
- Department of Anesthesiology
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Yeh JP, Sung PH, Chiang JY, Huang CR, Chen YL, Lai JP, Sheu JJ. Rejuvenated endothelial progenitor cells through overexpression of cellular prion protein effectively salvaged the critical limb ischemia in rats with preexisting chronic kidney disease. Stem Cell Res Ther 2022; 13:447. [PMID: 36056416 PMCID: PMC9440498 DOI: 10.1186/s13287-022-03119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study tested the hypothesis that overexpression of cellular prion protein in endothelial progenitor cells (PrPcOE-EPCs), defined as "rejuvenated EPCs," was superior to EPCs for salvaging the critical limb ischemia (CLI) induced after 28-day chronic kidney disease (CKD) induction in rat. METHODS AND RESULTS Cell viability and flow cytometric analyses of early/late apoptosis/total-intracellular ROS/cell cycle (sub-G1, G2/M phase) were significantly higher in EPCs + H2O2 than in EPCs that were significantly reversed in PrPcOE-EPCs + H2O2 (all p < 0.001). The protein expressions of inflammation (IL-1ß/IL-6/MMP-9/p-NF-κB) were significantly increased in EPC + TNF-α than in EPCs that were significantly reversed in PrPcOE-EPCs + TNF-α (all p < 0.001). Adult-male SD rats (n = 8/each group) were categorized into group 1 (sham-operated control), group 2 (CKD + CLI), group 3 [CKD + CLI + EPCs by intravenous (0.6 × 105)/intra-muscular (0.6 × 105) injections at 3 h after CLI induction], group 4 (CKD + CLI + PrPcOE-EPCs/dose-administration as group 3) and group 5 (CKD + CLI + siPrnp-EPCs/dose-administration as group 3). By day 14 after CLI induction, the ratio of ischemia to normal blood flow (INBF) in CLI area was highest in group 1/lowest in group 2/significantly higher in group 4 than in groups 3/5 and significantly higher in group 3 than in group 5 (all p < 0.0001). Histopathology demonstrated that the angiogenesis (number of small vessels/CD31 + cells) exhibited a similar trend, whereas the fibrosis/kidney injury score exhibited an opposite pattern of INBF among the groups (all p < 0.0001). The protein expressions of angiogenesis (SDF-1α/VEGF/CXCR4)/cell-stress signaling (p-PI3K/p-Akt/p-m-TOR) were significantly and progressively increased from groups 1-4 that were reversed in group 5 (all p < 0.0001). The protein expressions of fibrotic (p-Smad3/TGF-ß)/oxidative-stress (NOX-1/NOX-2/oxidized-protein)/apoptotic (mitochondrial-Bax/cleaved caspase3/cleaved PARP)/mitochondrial-damaged (cytosolic-cytochrome-C) biomarkers displayed an opposite pattern of INBF among the groups (all p < 0.0001). CONCLUSION PrPcOE-EPCs were superior to EPCs only therapy for salvaging the CLI.
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Affiliation(s)
- Jui-Po Yeh
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist., Kaohsiung City, 833253, Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833253, Taiwan.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, 804201, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 807378, Taiwan
| | - Chi-Ruei Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833253, Taiwan.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan
| | - Yi-Ling Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833253, Taiwan.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan
| | - Jui-Pin Lai
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist., Kaohsiung City, 833253, Taiwan.
| | - Jiunn-Jye Sheu
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan. .,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan. .,Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist., Kaohsiung, 83301, Taiwan.
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9
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Cofer LB, Soomro QH, Xia Y, Luttrell-Williams E, Myndzar K, Charytan DM, Berger JS. Platelet Activity and Cardiovascular Risk in CKD and Peripheral Artery Disease. Kidney Int Rep 2022; 7:2242-2250. [PMID: 36217517 PMCID: PMC9546761 DOI: 10.1016/j.ekir.2022.07.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Platelet dysfunction and cardiovascular risk are well-recognized features of chronic kidney disease (CKD). Platelets drive the development and progression of cardiovascular disease (CVD). The relationships between kidney function, platelet activity, and cardiovascular risk are poorly defined. Methods We compared platelet activity and incident cardiovascular events by CKD status (estimated glomerular filtration rate [eGFR] < 60 ml/min per 1.73 m2) using data from the Platelet Activity and Cardiovascular Events study, a prospective cohort study that enrolled adults with peripheral artery disease (PAD) undergoing lower extremity revascularization. Platelet activity was measured using light transmission aggregometry (LTA) in response to submaximal dose agonist stimulation, and the subjects were followed for incident adverse cardiovascular events for a median of 18 months. Results Overall, 113 of 285 (40%) subjects had CKD. Subjects with, versus without, CKD had higher platelet aggregation in response to stimulation with adenosine diphosphate (ADP), serotonin, epinephrine, and arachidonic acid (AA) + ex vivo aspirin (P < 0.05 for each). Following multivariable adjustment, subjects with CKD had elevated risk for myocardial infarction (MI) (adjusted hazard ratio 2.2, 95% confidence interval [1.02–4.9]) and major adverse cardiovascular events (MACE) (1.9 [1.2–3.3]) compared to those without CKD. Platelet aggregation in response to submaximal dose agonist stimulation mediated 7% to 26% of the excess risk for cardiovascular events associated with CKD. Conclusion Among subjects with PAD undergoing lower extremity revascularization, CKD is associated with increased platelet activity that mediates, in part, elevated cardiovascular risk.
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10
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Galarza Tapia A, Velescu A, Collado Nieto S, Cao Baduell H, Ruiz-Carmona C, Mateos Torres E, Redondo Pachon MD, Clara Velasco A. Kidney transplantation reduces the risk of chronic limb threatening ischemia and amputation among patients with end-stage renal disease on hemodialysis. Vascular 2022:17085381221078176. [PMID: 35451345 DOI: 10.1177/17085381221078176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to analyze the risk of chronic limb threatening ischemia (CLTI) or amputation among patients with end-stage renal disease (ESRD) entering a hemodialysis (HD) program and to evaluate the protective effect associated with kidney transplantation (KT). DESIGN, MATERIAL AND METHODS Retrospective cohort of all consecutive ESRD patients entering into a HD program at our institution between 2000 and 2010. Collected variables included baseline characteristics (pre-entry in hemodialysis), time on HD program, KT and the composite outcome of chronic limb threatening ischemia or need for any amputation (CLTI/AMP). Patients with previous symptomatic peripheral arterial disease or amputation were excluded. RESULTS The study group included 336 patients (mean age 63 years, 66% male). The mean follow up was 6.7 years with an average time on HD of 4.2 years. Ninety two patients (27.4 %) underwent transplantation. CLTI free survival rates were 90.3 % and 82.6 % at 5 and 10 years, respectively. The episodes of CLT involved 28 revascularization procedures (17 endovascular and 11 open surgeries), 18 minor amputations and 20 major amputations. KT was associated with a protective effect over the development of CLTI (HR: 0.065; CI 95% 0.02-0.21) after adjustment for confounding factors. The long-term survival of non-transplanted patients was 45 % and 15 % at 5 and 10 years, respectively and the long-term survival in transplanted patients was 89% and 80% at 5 and 10 years, respectively; but decreased to 47 % at 1 year and 18.2 % at 5 years once CLTI occurred. CONCLUSION Patients on HD program show a notorious risk of chronic limb threatening ischemia or amputation over time. Once this complication occurs, patient's survival is markedly reduced. Transplantation confers an independent protective effect over the development of chronic limb threatening ischemia or amputation.
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Affiliation(s)
- Andres Galarza Tapia
- Angiology and Vascular Surgery Department, 16546Hospital del Mar, Barcelona, Spain
| | - Alina Velescu
- Angiology and Vascular Surgery Department, 16546Hospital del Mar, Barcelona, Spain.,Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain.,CIBER Enfermedades Cardiovasculares, Barcelona, Spain
| | | | | | - Carlos Ruiz-Carmona
- Angiology and Vascular Surgery Department, 16546Hospital del Mar, Barcelona, Spain
| | | | | | - Albert Clara Velasco
- Angiology and Vascular Surgery Department, 16546Hospital del Mar, Barcelona, Spain.,Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain.,CIBER Enfermedades Cardiovasculares, Barcelona, Spain.,Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
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11
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Jelani QUA, Llanos-Chea F, Bogra P, Trejo-Paredes C, Huang J, Provance JB, Turner J, Anantha-Narayanan M, Sheikh AB, Smolderen KG, Mena-Hurtado C. Guideline-Directed Medical Therapy in Patients with Chronic Kidney Disease Undergoing Peripheral Vascular Intervention. Am J Nephrol 2021; 52:845-853. [PMID: 34706363 DOI: 10.1159/000519484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Guideline-directed medical therapy (GDMT) is imperative to improve cardiovascular and limb outcomes for patients with critical limb ischemia (CLI), especially amongst those at highest risk for poor outcomes, including those with comorbid chronic kidney disease (CKD). Our objective was to examine GDMT prescription rates and their variation across individual sites for patients with CLI undergoing peripheral vascular interventions (PVIs), by their comorbid CKD status. METHODS Patients with CLI who underwent PVI (October 2016-April 2019) were included from the Vascular Quality Initiative (VQI) database. CKD was defined as GFR <60 mL/min/1.73 m2. GDMT included the composite use of antiplatelet therapy and a statin, as well as an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker if hypertension was present. The use of GDMT before and after the index procedure was summarized in those with and without CKD. Adjusted median odds ratios (MORs) for site variability were calculated. RESULTS The study included 28,652 patients, with a mean age of 69.4 ± 11.7 years, and 40.8% were females. A total of 47.5% had CKD. Patients with CKD versus those without CKD had lower prescription rates both before (31.7% vs. 38.9%) and after (36.5% vs. 48.8%) PVI (p < 0.0001). Significant site variability was observed in the delivery of GDMT in both the non-CKD and CKD groups before and after PVI (adjusted MORs: 1.31-1.41). DISCUSSION/CONCLUSION In patients with CLI undergoing PVI, patients with comorbid CKD were less likely to receive GDMT. Significant variability of GDMT was observed across sites. These findings indicate that significant improvements must be made in the medical management of patients with CLI, particularly in patients at high risk for poor clinical outcomes.
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Affiliation(s)
- Qurat-Ul-Ain Jelani
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Fiorella Llanos-Chea
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Pragati Bogra
- Department of Internal Medicine, Griffin Hospital, Derby, Connecticut, USA
| | - Camila Trejo-Paredes
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Jiaming Huang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jeremy B Provance
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey Turner
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Azfar Bilal Sheikh
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Kim G Smolderen
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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12
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Serra R, Bracale UM, Ielapi N, Del Guercio L, Di Taranto MD, Sodo M, Michael A, Faga T, Bevacqua E, Jiritano F, Serraino GF, Mastroroberto P, Provenzano M, Andreucci M. The Impact of Chronic Kidney Disease on Peripheral Artery Disease and Peripheral Revascularization. Int J Gen Med 2021; 14:3749-3759. [PMID: 34326661 PMCID: PMC8315808 DOI: 10.2147/ijgm.s322417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/05/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) is a clinical condition characterized by high morbidity and mortality. Globally, CKD is also increasing in prevalence and incidence. The two principal kidney measures namely estimated glomerular filtration rate (eGFR) and albuminuria have been found to be predictors of renal and cardiovascular (CV) endpoints including peripheral artery disease (PAD). The prevalence of PAD was increased in CKD patients and, particularly, in patients with more severe CKD stages. Despite the fact that revascularization strategies are suitable in CKD patients in similar fashion to non-CKD patients, few CKD patients underwent these procedures. In fact, if it is true that revascularization improves prognosis in PAD patients irrespective of baseline eGFR, it was also demonstrated that CKD patients, who underwent revascularization, were at higher risk for amputations, mortality, re-intervention and perioperative complications. With the present review article, we have examined the association between CKD, PAD and peripheral revascularization highlighting data about epidemiology, pathophysiologic mechanisms, and results from previous observational and intervention studies. We have also examined the future perspectives and challenges of research around the association between CKD and PAD.
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Affiliation(s)
- Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), "Magna Graecia" University, Catanzaro, Italy.,Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | | | - Nicola Ielapi
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, Roma, 00185, Italy
| | - Luca Del Guercio
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Maria Donata Di Taranto
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy
| | - Maurizio Sodo
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Ashour Michael
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Teresa Faga
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Egidio Bevacqua
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy
| | - Federica Jiritano
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy
| | | | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy
| | - Michele Provenzano
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Michele Andreucci
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
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13
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Johansen KL, Garimella PS, Hicks CW, Kalra PA, Kelly DM, Martens S, Matsushita K, Sarafidis P, Sood MM, Herzog CA, Cheung M, Jadoul M, Winkelmayer WC, Reinecke H. Central and peripheral arterial diseases in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2021; 100:35-48. [PMID: 33961868 PMCID: PMC9833277 DOI: 10.1016/j.kint.2021.04.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 02/08/2023]
Abstract
Chronic kidney disease (CKD) affects about 10% of all populations worldwide, with about 2 million people requiring dialysis. Although patients with CKD are at high risk of cardiovascular disease and events, they are often underrepresented or excluded in clinical trials, leading to important knowledge gaps about how to treat these patients. KDIGO (Kidney Disease: Improving Global Outcomes) convened the fourth clinical Controversies Conference on the heart, kidney and vasculature in Dublin, Ireland, in February 2020, entitled Central and Peripheral Arterial Diseases in Chronic Kidney Disease. A global panel of multidisciplinary experts from the fields of nephrology, cardiology, neurology, surgery, radiology, vascular biology, epidemiology, and health economics attended. The objective was to identify key issues related to the optimal detection, management, and treatment of cerebrovascular diseases, central aortic disease, renovascular disease, and peripheral artery disease in the setting of CKD. This report outlines the common pathophysiology of these vascular processes in the setting of CKD, describes best practices for their diagnosis and management, summarizes areas of uncertainty, addresses ongoing controversial issues, and proposes a research agenda to address key gaps in knowledge that, when addressed, could improve patient care and outcomes.
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Affiliation(s)
- Kirsten L Johansen
- Division of Nephrology, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Division of Nephrology, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Pranav S Garimella
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK; Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Dearbhla M Kelly
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Sven Martens
- Department of Cardiothoracic Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus, Münster, Germany
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Pantelis Sarafidis
- Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Charles A Herzog
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Division of Cardiology, Hennepin Healthcare, Minneapolis, Minnesota, USA; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes (KDIGO), Brussels, Belgium
| | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Holger Reinecke
- Department of Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany.
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14
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Morooka H, Tanaka A, Inaguma D, Maruyama S. Peripheral artery disease at the time of dialysis initiation and mortality: a prospective observational multicenter study. BMJ Open 2020; 10:e042315. [PMID: 33384396 PMCID: PMC7780557 DOI: 10.1136/bmjopen-2020-042315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Patients with peripheral artery disease (PAD) are reported to have a poorer prognosis than those without PAD. PAD is sometimes found at dialysis initiation, but its influence on the prognosis in these patients has not been investigated. We aimed to compare the mortality rate between patients with PAD at the time of dialysis initiation and those without PAD. DESIGN We undertook an observational prospective multicenter study of patients starting dialysis treatment. Data were collected on patients' sex, age, presence of PAD, medication, medical history and clinical and laboratory data. SETTING Seventeen centers participated in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis. PARTICIPANTS A total of 1524 patients with chronic kidney disease started dialysis from October 2011 to September 2013. The patients were followed-up until March 2015. During this time, there were two patients who lost the follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was defined as all-cause mortality. The secondary outcomes were defined as each cause of mortality. RESULTS This study included 1030 men and 492 women with a mean age of 67.50±13.10 years. Of these, 71 had PAD and 1451 did not have PAD. After a median follow-up of 814.5 days, 33.80% of the former group and 17.00% of the latter group had died in March 2015 (p=0.001). After adjusting for confounding factors, PAD at dialysis initiation remained an independent risk factor for mortality (p<0.01). CONCLUSIONS Patients with PAD at the time of dialysis initiation had a poorer prognosis than patients without PAD. Therefore, the presence of PAD in patients starting dialysis should be considered for their monitoring and follow-up.
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Affiliation(s)
- Hikaru Morooka
- Departmnt of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Akihito Tanaka
- Departmnt of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Daijo Inaguma
- Department of Nephrology, Fujita Health University, Toyoake, Aichi, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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15
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Anantha-Narayanan M, Sheikh AB, Nagpal S, Jelani QUA, Smolderen KG, Regan C, Ionescu C, Ochoa Chaar CI, Schneider M, Llanos-Chea F, Mena-Hurtado C. Systematic review and meta-analysis of outcomes of lower extremity peripheral arterial interventions in patients with and without chronic kidney disease or end-stage renal disease. J Vasc Surg 2020; 73:331-340.e4. [PMID: 32889074 DOI: 10.1016/j.jvs.2020.08.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with chronic kidney disease (CKD) have a greater risk of peripheral arterial disease (PAD). Although individual studies have documented an association between CKD and/or end-stage renal disease (ESRD) and adverse outcomes in patients undergoing PAD interventions in an era of technological advances in peripheral revascularization, the magnitude of the effect size is unknown. Therefore, we performed a meta-analysis to compare the outcomes of PAD interventions for patients with CKD/ESRD with those patients with normal renal function, stratified by intervention type (endovascular vs surgical), reflecting contemporary practice. METHODS Five databases were analyzed from January 2000 to June 2019 for studies that had compared the outcomes of lower extremity PAD interventions for patients with CKD/ESRD vs normal renal function. We included both endovascular and open interventions, with an indication of either claudication or critical limb ischemia. We analyzed the pooled odds ratios (ORs) across studies with 95% confidence intervals (CIs) using a random effects model. Funnel plot and exclusion sensitivity analyses were used for bias assessment. RESULTS Seventeen observational studies with 13,140 patients were included. All included studies, except for two, had accounted for unmeasured confounding using either multivariable regression analysis or case-control matching. The maximum follow-up period was 114 months (range, 0.5-114 months). The incidence of target lesion revascularization (TLR) was greater in those with CKD/ESRD than in those with normal renal function (OR, 1.68; 95% CI, 1.25-2.27; P = .001). The incidence of major amputations (OR, 1.97; 95% CI, 1.37-2.83; P < .001) and long-term mortality (OR, 2.28; 95% CI, 1.45-3.58; P < .001) was greater in those with CKD/ESRD. The greater TLR rates with CKD/ESRD vs normal renal function were only seen with endovascular interventions, with no differences for surgical interventions. The differences in rates of major amputations and long-term mortality between the CKD/ESRD and normal renal function groups were statistically significant, regardless of the intervention type. CONCLUSIONS Patients with CKD/ESRD who have undergone lower extremity PAD interventions had worse outcomes than those of patients with normal renal function. When stratifying our results by intervention (endovascular vs open surgery), greater rates of TLR for CKD/ESRD were only seen with endovascular and not with open surgical approaches. Major amputations and all-cause mortality were greater in the CKD/ESRD group, irrespective of the indication. Evidence-based strategies to manage this at-risk population who require PAD interventions are essential.
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Affiliation(s)
| | - Azfar Bilal Sheikh
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | - Sameer Nagpal
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | - Qurat-Ul-Ain Jelani
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | - Kim G Smolderen
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | - Christopher Regan
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | - Costin Ionescu
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | | | - Marabel Schneider
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
| | | | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Conn
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16
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Giannopoulos S, Lyden SP, Bisdas T, Micari A, Parikh SA, Jaff MR, Schneider PA, Armstrong EJ. Endovascular Intervention for the Treatment of Trans-Atlantic Inter-Society Consensus (TASC) D Femoropopliteal Lesions: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 22:52-65. [PMID: 32563709 DOI: 10.1016/j.carrev.2020.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Advancements in the endovascular treatment of femoropopliteal atherosclerotic lesions have led to treatment of more complex lesions, particularly long lesions. The aim of this study was to determine the meta-analytic primary patency and need for re-intervention among patients treated for very long lesions (>200 mm) at the femoropopliteal segment and to identify potential risk factors for loss of patency. METHODS This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted, and the I-square was used to assess heterogeneity. RESULTS Fifty-one studies comprised of 3029 patients were included. The mean lesion length was 269 mm. The primary patency rate at 30 days, 6 m, 1-, 2- and 5-years of follow-up was 98%, 76%, 62%, 55%, and 39% respectively. The incidence of TLR was 16% at one year and 32% at two years. The secondary patency rate at 1, 2, 3 and 5 years was 85%, 71%, 64%, and 64% respectively. Heparin bonded ePTFE covered stents (69%) and paclitaxel eluting stents (73%) demonstrated higher 1-year primary patency rates than self-expanding nitinol stents (55%) or uncoated percutaneous transluminal angioplasty (PTA) with provisional stenting (54%). Lesions treated with a heparin bonded ePTFE covered stent had statistically significant higher odds of remaining patent at 1-year of follow-up (OR: 2.74; 95%CI: 1.63-4.61; p < 0.001) than lesions treated with BMS or PTA. Patients with long femoropopliteal lesions causing critical limb ischemia (CLI) developed restenosis or occlusion more often than patients treated for claudication (HR: 1.63; 95%CI: 1.06-2.49; p = 0.026) during an average follow-up of 26 months. CONCLUSION Primary stenting of femoropopliteal TASC D lesions using drug eluting stents or covered stents results in sustained patency over time. PTA or uncoated nitinol stents demonstrated lower patency rates. However, additional comparative studies are needed to determine the efficacy of newer technologies for the treatment of complex femoropopliteal lesions and provide evidence for the most optimal treatment approach.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Sean P Lyden
- Department of Vascular Surgery, Cleveland Clinic and Foundation, Cleveland, OH, USA
| | | | - Antonio Micari
- Division of Cardiology, Huamitas Gavazzeni, Bergamo, Italy
| | - Sahil A Parikh
- Center for Interventional Vascular Therapy, NY Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael R Jaff
- Department of Medicine, Newton-Wellesley Hospital, Newton, MA, USA
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.
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17
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Lee SC, Quan C, Mun JH, Lee SS. Efficacy of Regional Anesthesia in Secondary Procedures or Revisions of Arteriovenous Fistula. Ann Vasc Surg 2020; 71:191-199. [PMID: 32479876 DOI: 10.1016/j.avsg.2020.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/02/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Several factors affect the outcomes of arteriovenous fistula (AVF) and end-stage renal disease (ESRD). This study aimed to evaluate the efficacy of regional anesthesia in secondary procedures or revisions of AVF. METHODS Medical records of patients who underwent treatment for AVF secondary procedures or revisions under brachial plexus block (BPB) between March 2016 and June 2019 were retrospectively analyzed. Patient characteristics and clinical outcomes were evaluated. RESULTS In total, 375 patients (mean age 65.6 ± 12.74; males 210, 56.0%) were enrolled in the study and 770 procedures were performed under BPB for AVF secondary procedures or revisions. The procedures included endovascular treatment (385, 50.0%), surgical treatment (105, 13.6%), and hybrid treatment (280, 36.4%). In 180 procedures (23.4%) for AVF lesions, the operative field included a single segment of the arm, whereas in 590 procedures (76.6%), the operative field included multiple segments. In total, 37 (4.8%) cases of 30-day postoperative complications were observed, of which 33 (4.3%) were surgery-related complications, 2 (0.3%) were BPB-related complications (neurapraxia), and 2 (0.3%) were contrast agent allergic reactions; 34 (4.4%) reinterventions of the total 201 (26.1%) reinterventions were performed within 30 days postoperatively. The mean operation time was 87.5 ± 55.35 min. The pain score for all patients was 0 (no pain), and no patient demanded opioids postoperatively. CONCLUSIONS Ultrasound-guided BPB is safe and effective for AVF secondary procedures or revisions in ESRD patients.
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Affiliation(s)
- Soon Chon Lee
- Division of Vascular and Endovascular Surgery, Gwangyang Sarang General Hospital, Gwangyang, South Korea
| | - Cheng Quan
- Department of Vascular Surgery, The Second Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Jin Ho Mun
- Research Institute for Convergence of Biomedical Science and Technology, Division of Vascular and Endovascular Surgery, Department of Surgery, Yangsan Hospital, Pusan National University, Yangsan, South Korea
| | - Sang Su Lee
- Research Institute for Convergence of Biomedical Science and Technology, Division of Vascular and Endovascular Surgery, Department of Surgery, Yangsan Hospital, Pusan National University, Yangsan, South Korea.
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18
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Moussa Pacha H, Al-Khadra Y, Darmoch F, Soud M, Mamas MA, Moussa Pacha A, Zaitoun A, Kaki A, AlJaroudi WA, Alraies MC. In-hospital outcome of peripheral vascular intervention in dialysis-dependent end-stage renal disease patients. Catheter Cardiovasc Interv 2019; 95:E84-E95. [PMID: 31631511 DOI: 10.1002/ccd.28522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/26/2019] [Accepted: 09/17/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The impact of end-stage renal disease (ESRD) on peripheral vascular intervention (PVI) outcome remains incompletely elucidated. OBJECTIVES We sought to compare the outcome of PVI in dialysis patients with those with normal kidney function. METHODS Using weighted data from the National Inpatient Sample database between 2002 and 2014, we identified all peripheral artery disease (PAD) patients aged ≥18 years that underwent PVI. Multivariate logistic regression analysis was performed to examine in-hospital outcomes. RESULTS Of 1,186,192 patients who underwent PVI, 1,066,830 had normal kidney function (89.9%) and 119,362 had ESRD requiring dialysis (10.1%). Critical limb ischemia was more prevalent in dialysis patients (63.2 vs. 34.0%, p < .001). Compared with normal kidney function group, ESRD requiring dialysis was associated with higher in-hospital mortality (1.5 vs. 4.2%, adjusted OR: 2.13 [95% CI: 2.04-2.23]) and longer length of hospital stay (median 3 days, Interquartile range [IQR] (0-6) vs. 7 days, IQR (4-18); p < .001). Dialysis patients had higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke; 14.3 vs. 9.8%, p < .001) and net adverse cardiovascular events (composite of MACE, major bleeding, or vascular complications; 40.8 vs. 29.1%, p < .001). ESRD patients less frequently underwent open bypass (5.6 vs. 8.5%, p < .001) and more frequently had major amputation (10.3 vs. 3.0%, p < .001) compared with normal kidney function group. CONCLUSION PAD patients on dialysis who underwent PVI have higher rates of mortality and adverse outcomes as compared to those with normal kidney function.
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Affiliation(s)
- Homam Moussa Pacha
- Cardiology Department, McGovern Medical School, Memorial Hermann Heart & Vascular Institute, University of Texas Health Science Center, Houston, Texas
| | - Yasser Al-Khadra
- Internal Medicine Department, Cleveland Clinic, Medicine Institute, Cleveland, Ohio
| | - Fahed Darmoch
- Internal Medicine Department, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Mohamad Soud
- Cardiology Department, Rutgers University, New Brunswick, New Jersey
| | - Mamas A Mamas
- Cardiology Department, Keele Cardiovascular Group, Centre for Prognosis Research, Institute of primary Care and Health sciences, Keele University, Stoke-on-Trent, UK
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Anwar Zaitoun
- Cardiology Department, St. John Hospital and Medical center, Detroit, Michigan
| | - Amir Kaki
- Cardiology Department, St. John Hospital and Medical center, Detroit, Michigan
| | - Wael A AlJaroudi
- Cardiology Department, Clemenceau Medical Center, Beirut, Lebanon
| | - M Chadi Alraies
- Cardiology Department, Detroit Medical Center, Wayne State University, Detroit Heart Hospital, Detroit, Michigan
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19
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Arinze NV, Gregory A, Francis JM, Farber A, Chitalia VC. Unique aspects of peripheral artery disease in patients with chronic kidney disease. Vasc Med 2019; 24:251-260. [PMID: 30823859 DOI: 10.1177/1358863x18824654] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Peripheral artery disease (PAD) represents a major health care burden. Despite the advent of screening and interventional procedures, the long-term clinical outcomes remain suboptimal, especially in patients with chronic kidney disease (CKD). While CKD and PAD share common predisposing factors, emerging studies indicate that their co-existence is not merely an association; instead, CKD represents a strong, independent risk factor for PAD. These findings implicate CKD-specific mediators of PAD that remain incompletely understood. Moreover, there is a need to understand the mechanisms underlying poor outcomes after interventions for PAD in CKD. This review discusses unique clinical aspects of PAD in patients with CKD, including high prevalence and worse outcomes after vascular interventions and the influence of renal allograft transplantation. In doing so, it also highlights underappreciated aspects of PAD in patients with CKD, such as disparities in revascularization and higher peri-procedural mortality. While previous reviews have discussed general mechanisms of PAD pathogenesis, focusing on PAD in CKD, this review underscores a need to probe for CKD-specific pathogenic pathways that may unravel novel biomarkers and therapeutic targets in PAD and ultimately improve the risk stratification and management of patients with CKD and PAD.
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Affiliation(s)
- Nkiruka V Arinze
- 1 Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.,2 Renal Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | | | - Jean M Francis
- 2 Renal Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Alik Farber
- 1 Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Vipul C Chitalia
- 2 Renal Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.,4 Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA.,5 Veterans Affairs Boston Healthcare System, Boston, MA, USA
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20
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Clinical outcomes of bypass-first versus endovascular-first strategy in patients with chronic limb-threatening ischemia due to infrageniculate arterial disease. J Vasc Surg 2019; 69:156-163.e1. [DOI: 10.1016/j.jvs.2018.05.244] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/19/2018] [Indexed: 11/17/2022]
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21
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Lynch KE, Chang JW, Matheny ME, Goldfarb A, Efimova O, Coronado G, DuVall SL. Comparison of automated and retrospectively calculated estimated glomerular filtration rate in electronic health record data. BMC Nephrol 2018; 19:380. [PMID: 30593275 PMCID: PMC6311049 DOI: 10.1186/s12882-018-1179-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) is the clinical standard for assessing kidney function and staging chronic kidney disease. Automated reporting of eGFR using the Modification of Diet in Renal Disease (MDRD) study equation was first implemented within the Department of Veterans Affairs (VA) in 2007 with staggered adoption across laboratories. When automated eGFR are not used or unavailable, values are retrospectively calculated using clinical and demographic data that are currently available in the electronic health record (EHR). Due to the dynamic nature of EHRs, current data may not always match past data. Whether and to what extent the practice of re-calculating eGFR on retrospective data differs from using the automated values is unknown. METHODS We assessed clinical data for patients enrolled in VA who had their first automated eGFR lab in 2013.We extracted the eGFR value, the corresponding serum creatinine value, and patient race, gender, and date of birth from the EHR. The MDRD equation was applied to retrospectively calculate eGFR. Stage of chronic kidney disease (CKD) was defined using both eGFR values. We used Bland-Altman plots and percent agreement to assess the difference between the automated and calculated values. We developed an algorithm to select the most parsimonious parameter set to explain the difference in values and used chart review on a small subsample of patients to determine if one approach more accurately describes the patient at the time of eGFR measurement. RESULTS We evaluated eGFR data pairs from 266,084 patients. Approximately 33.0% (n = 86,747) of eGFR values differed between automated and retrospectively calculated methods. The majority of discordant pairs were classified as the same CKD stage (n = 74,542, 85.93%). The Bland-Altman plot showed differences in the data pairs were centered near zero (mean difference: 0.8 mL/min/1.73m2) with 95% limits of agreement between - 6.4 and 8.0. A change in recorded age explained 95.6% (n = 78,903) of discordant values and 85.02% (n = 9371) of the discordant stages. CONCLUSIONS Values of retrospectively calculated eGFR can differ from automated values, but do not always result in a significant classification change. In very large datasets these small differences could become significant.
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Affiliation(s)
- Kristine E Lynch
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA. .,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Ji Won Chang
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Michael E Matheny
- Geriatrics Research Education and Clinical Care Center, Tennessee Valley Healthcare System, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander Goldfarb
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Olga Efimova
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Gregorio Coronado
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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22
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Yuo TH, Wallace JR, Fish L, Avgerinos ED, Leers SA, Al-Khoury GE, Makaroun MS, Chaer RA. Editor's Choice - Comparison of Outcomes After Open Surgical and Endovascular Lower Extremity Revascularisation Among End Stage Renal Disease Patients on Dialysis. Eur J Vasc Endovasc Surg 2018; 57:248-257. [PMID: 30385187 DOI: 10.1016/j.ejvs.2018.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 09/05/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES End stage renal disease (ESRD) patients with peripheral arterial disease (PAD) are at high risk of complications following open surgical revascularisation (OSR). Endovascular revascularisation (ER) is an option, but its role is unclear. This study sought to characterise the outcomes of ER and OSR in ESRD patients treated for claudication or critical limb ischaemia (CLI). METHODS The United States Renal Data System was used to investigate outcomes after lower extremity ER and OSR from 2005 to 2011. Primary outcomes were mortality, amputation, and peri-procedural myocardial infarction (MI). Kaplan-Meier (K-M) estimates were generated for mortality and amputation, logistic regression models for 30 day predictors, and proportional hazards models for long-term predictors. RESULTS A total of 20,347 patients underwent OSR and ER (20.3% OSR, 79.7% ER). CLI was the indication in 80.8% of ER and 88.4% of OSR. The unadjusted major amputation rate at 30 days was higher after ER compared with OSR (8.8% vs. 6.4%, p < .001). Conversely, the unadjusted mortality rate at 30 days was lower after ER compared with OSR (8.0% vs. 10.5%, p < .001). Multivariable logistic regression models adjusting for medical covariables and CLI versus claudication status demonstrated increased 30 day mortality risk with OSR compared with ER (OR 2.00, 95% CI 1.43-1.79, p < .001), MI (OR 1.38, 1.23-1.54, p < .001), and the combined endpoint of mortality and major amputation (OR 1.57, 1.16-2.12, p = .004), but lower odds of 30 day major amputation alone (OR 0.67, 0.58-0.77, p < .001). Proportional hazards models demonstrated increased long-term mortality risk with OSR compared with ER (HR 1.05, 1.00-1.09, p = .037), without a difference in major amputation (HR 0.99, 0.93-1.05, p = NS). CONCLUSIONS In this retrospective analysis of an administrative database, ESRD patients suffer from high mortality and amputation rates following lower extremity revascularisation. Compared with ER, OSR is associated with higher mortality. OSR has better 30 day limb salvage, although long-term outcomes are similar.
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Affiliation(s)
- Theodore H Yuo
- Department of Surgery, University of Pittsburgh School of Medicine, PA, USA.
| | | | - Larry Fish
- Department of Surgery, University of Pittsburgh School of Medicine, PA, USA
| | | | - Steven A Leers
- Department of Surgery, University of Pittsburgh School of Medicine, PA, USA
| | | | - Michel S Makaroun
- Department of Surgery, University of Pittsburgh School of Medicine, PA, USA
| | - Rabih A Chaer
- Department of Surgery, University of Pittsburgh School of Medicine, PA, USA
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23
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Nationwide Trends in Hospital Outcomes and Utilization After Lower Limb Revascularization in Patients on Hemodialysis. JACC Cardiovasc Interv 2018; 10:2101-2110. [PMID: 29050629 DOI: 10.1016/j.jcin.2017.05.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/24/2017] [Accepted: 05/21/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to describe the temporal trends and outcomes of endovascular and surgical revascularization in a large, nationally representative sample of patients with end-stage renal disease on hemodialysis hospitalized for peripheral artery disease (PAD). BACKGROUND PAD is prevalent among patients with end-stage renal disease on hemodialysis and is associated with significant morbidity and mortality. There is a paucity of information on trends in endovascular and surgical revascularization and post-procedure outcomes in this population. METHODS We used the Nationwide Inpatient Sample (2002 to 2012) to identify hemodialysis patients undergoing endovascular or surgical procedures for PAD using diagnostic and procedural codes. We compared trends in amputation, post-procedure complications, mortality, length of stay, and costs between the 2 groups using trend tests and logistic regression. RESULTS There were 77,049 endovascular and 29,556 surgical procedures for PAD in hemodialysis patients. Trend analysis showed that endovascular procedures increased by nearly 3-fold, whereas there was a reciprocal decrease in surgical revascularization. Post-procedure complication rates were relatively stable in persons undergoing endovascular procedures but nearly doubled in those undergoing surgery. Surgery was associated with 1.8 times adjusted odds (95% confidence interval: 1.60 to 2.02) for complications and 1.6 times the adjusted odds for amputations (95% confidence interval: 1.40 to 1.75) but had similar mortality (adjusted odds ratio: 1.05; 95% confidence interval: 0.85 to 1.29) compared with endovascular procedures. Length of stay for endovascular procedures remained stable, whereas a decrease was seen for surgical procedures. Overall costs increased marginally for both procedures. CONCLUSIONS Rates of endovascular procedures have increased, whereas those of surgeries have decreased. Surgical revascularization is associated with higher odds of overall complications. Further prospective studies and clinical trials are required to analyze the relationship between the severity of PAD and the revascularization strategy chosen.
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24
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Zou H, Hong Q, Xu G. Early versus late initiation of renal replacement therapy impacts mortality in patients with acute kidney injury post cardiac surgery: a meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017. [PMID: 28623953 PMCID: PMC5474059 DOI: 10.1186/s13054-017-1707-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Acute kidney injury (AKI) is a common clinical complication of cardiac surgery and increases mortality and hospitalization. We aimed to explore and perform an updated meta-analysis of qualitative and quantitative evaluations of the relationship between early renal replacement therapy (RRT) and mortality. Methods We searched the Chinese Biomedical Database, the Cochrane Library, EMBASE, Global Health, MEDLINE and PubMed. Results Fifteen studies (five randomized controlled trials (RCTs), one prospective cohort and nine retrospective cohorts) including 1479 patients were identified for detailed evaluation. The meta-analysis suggested that early RRT initiation reduced 28-day mortality (odds ratio (OR) 0.36; 95% confidence interval (CI) 0.23 to 0.57; I2 60%), and shortened intensive care unit (ICU) length of stay (LOS) (mean difference (MD) -2.50; 95% CI -3.53 to -1.47; I2 88%) and hospital LOS (MD -0.69; 95% CI -1.13 to -0.25; I2 88%), and also reduced the duration of RRT (MD -1.18; 95% CI -2.26 to -0.11; I2 69%), especially when RRT was initiated early within 12 hours (OR 0.23; 95% CI 0.08 to 0.63; I2 73%) and within 24 hours (OR 0.52; 95% CI 0.28 to 0.95; I2 58%) in patients with AKI after cardiac surgery. Conclusions Early RRT initiation decreased 28-day mortality, especially when it was started within 24 hours after cardiac surgery in patients with AKI.
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Affiliation(s)
- Honghong Zou
- Medical Center of the Graduate School, Nanchang University, Nanchang, People's Republic of China.,Department of Nephrology, the Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, People's Republic of China
| | - Qianwen Hong
- Science and Technology College, Jiangxi University of Traditional Chinese Medicine, Nanchang, People's Republic of China
| | - Gaosi Xu
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, People's Republic of China.
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25
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Baer-Bositis HE, Hicks TD, Haidar GM, Sideman MJ, Pounds LL, Davies MG. Outcomes of Isolated Tibial Endovascular Intervention for Rest Pain in Patients on Dialysis. Ann Vasc Surg 2017; 46:118-126. [PMID: 28479421 DOI: 10.1016/j.avsg.2017.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tibial interventions for critical limb ischemia are frequent in patients with end-stage renal disease (ESRD) presenting with critical ischemia. The aim of this study was to examine impact of ESRD on the patient-centered outcomes following tibial endovascular Intervention for rest pain. METHODS A database of patients undergoing lower extremity endovascular interventions between 2006 and 2016 was retrospectively queried. Patients with rest pain (Rutherford 4) were identified. Patients with claudication (Rutherford 1 to 3) and tissue loss (Rutherford 5 and 6) were excluded. Patients were categorized by the presence or absence of ESRD. Patient-orientated outcomes of clinical efficacy (CE; absence of recurrent symptoms, maintenance of ambulation, and absence of major amputation), amputation-free survival (AFS; survival without major amputation), and freedom from major adverse limb events (MALEs; above ankle amputation of the index limb or major reintervention new bypass graft, jump/interposition graft revision) were evaluated. RESULTS A total of 829 patients (56% male, average age 59 years; 658 nonhemodialysis [non-HD] and 171 HD) underwent isolated tibial intervention in one leg for rest pain. Technical success was 99% with a median of 2 vessels treated per patient. There was no difference in the distribution of Trans-Atlantic Inter-Society Consensus I lesions, but both the modified Society for Vascular Surgery (SVS) runoff score and the pedal runoff score were worse in the HD group. The 30-day major adverse cardiac events and 30-day MALEs were equivalent in both groups. CE was 38 ± 9% and 19 ± 8% at 5 years for the non-HD and HD groups, respectively (P < 0.01). Overall, AFS was 45 ± 8% and 18 ± 9% at 5 years for the non-HD and HD groups, respectively (P < 0.01). Freedom from MALE was 41 ± 9% and 21 ± 8% at 5 years for the non-HD and HD groups, respectively (P < 0.01). CONCLUSIONS Patients with ESRD who present with rest pain have equivalent short-term outcomes to those not on dialysis but do not achieve long-term satisfactory CE and AFS after isolated tibial intervention for rest pain.
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Affiliation(s)
- Hallie E Baer-Bositis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Center for Vascular Care, University Hospital System, San Antonio, TX
| | - Taylor D Hicks
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Center for Vascular Care, University Hospital System, San Antonio, TX
| | - Georges M Haidar
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Center for Vascular Care, University Hospital System, San Antonio, TX
| | - Matthew J Sideman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Center for Vascular Care, University Hospital System, San Antonio, TX
| | - Lori L Pounds
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Center for Vascular Care, University Hospital System, San Antonio, TX
| | - Mark G Davies
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX; South Texas Center for Vascular Care, University Hospital System, San Antonio, TX.
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Flores E, Lewinger JP, Rowe VL, Woo K, Weaver FA, Shavelle D, Clavijo L, Garg PK. Increased risk of mortality after lower extremity bypass in individuals with acute kidney injury in the Vascular Quality Initiative. J Vasc Surg 2017; 65:1055-1061. [DOI: 10.1016/j.jvs.2016.09.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/08/2016] [Indexed: 01/22/2023]
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Zhou C, Bulluck H, Fang N, Li L, Hausenloy DJ. Age and Surgical Complexity impact on Renoprotection by Remote Ischemic Preconditioning during Adult Cardiac Surgery: A Meta analysis. Sci Rep 2017; 7:215. [PMID: 28303021 PMCID: PMC5428278 DOI: 10.1038/s41598-017-00308-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/16/2017] [Indexed: 01/31/2023] Open
Abstract
We aimed to conduct an up-to-date meta-analysis to comprehensively assess the renoprotective effect of remote ischemic preconditioning (RIPC) in patients undergoing adult cardiac surgery. 21 randomized controlled trials (RCTs) with a total of 6302 patients were selected and identified. Compared with controls, RIPC significantly reduced the incidence of acute kidney injury (AKI) [odds ratio (OR) = 0.79; P = 0.02; I2 = 38%], and in particular, AKI stage I (OR = 0.65; P = 0.01; I2 = 55%). RIPC significantly shortened mechanical ventilation (MV) duration [weighted mean difference (WMD) = −0.79 hours; P = 0.002; I2 = 53%), and reduced intensive care unit (ICU) stay (WMD = −0.23 days; P = 0.07; I2 = 96%). Univariate meta-regression analyses showed that the major sources of heterogeneity for AKI stage I were age (coefficient = 0.06; P = 0.01; adjusted R2 = 0.86) and proportion of complex surgery (coefficient = 0.02; P = 0.03; adjusted R2 = 0.81). Subsequent multivariate regression and subgroup analyses also confirmed these results. The present meta-analysis suggests that RIPC reduces the incidence of AKI in adults undergoing cardiac surgery and this benefit was more pronounced in younger patients undergoing non-complex cardiac surgery. RIPC may also shorten MV duration and ICU stay. Future RCTs tailored for those most likely to benefit from RIPC warrants further investigation.
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Affiliation(s)
- Chenghui Zhou
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.,The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Nengxin Fang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Lihuan Li
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.,The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
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Matsumi J, Tobita K, Shishido K, Mizuno S, Yamanaka F, Murakami M, Tanaka Y, Takahashi S, Akasaka T, Saito S. Long-term outcomes of SMART stent implantation in patients with femoro-popliteal disease. Catheter Cardiovasc Interv 2016; 88:832-841. [DOI: 10.1002/ccd.26718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 06/01/2016] [Accepted: 07/21/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Junya Matsumi
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Kazuki Tobita
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Koki Shishido
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Shingo Mizuno
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Masato Murakami
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Saeko Takahashi
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Takeshi Akasaka
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization; Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital; Kamakura Japan
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Chaudhry SA, Afzal MR, Kassab A, Hussain SI, Qureshi AI. A New Risk Index for Predicting Outcomes among Patients Undergoing Carotid Endarterectomy in Large Administrative Data Sets. J Stroke Cerebrovasc Dis 2016; 25:1978-83. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/28/2015] [Accepted: 01/16/2016] [Indexed: 11/16/2022] Open
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Parvataneni KC, Piyaskulkaew C, Szpunar S, Sharma T, Patel V, Patel S, Davis T, Lalonde T, Yamasaki H, Rosman HS, Mehta RH. Relation of Baseline Renal Dysfunction With Outcomes in Patients Undergoing Popliteal and Infrapopliteal Percutaneous Peripheral Arterial Interventions. Am J Cardiol 2016; 118:298-302. [PMID: 27236250 DOI: 10.1016/j.amjcard.2016.04.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
Renal dysfunction is a major risk factor for peripheral arterial disease (PAD). Infrapopliteal PAD is associated with more co-morbid conditions and worse prognosis than suprapopliteal PAD. Long-term outcomes of patients with renal dysfunction and popliteal or infrapopliteal PAD undergoing peripheral vascular intervention (PVI) are not well described. We retrospectively evaluated long-term outcomes in 726 patients undergoing infrapopliteal PVI categorized into 3 glomerular filtration rate (GFR)-based groups: GFR (≥60 ml/min/1.73 m(2)), GFR (<60 ml/min/1.73 m(2)), and those on dialysis. At mean follow-up of 36 ± 20 months, amputation rates were 3%, 5%, and 11% with mortality rates of 23%, 36%, and 56% in normal renal function, chronic kidney disease (adjusted odds ratio [OR] for amputation 1.75, 95% CI 0.73 to 4.21; adjusted OR for mortality 1.53, 95% CI 1.05 to 2.23, p = 0.028), and dialysis (adjusted OR for amputation 2.43, 95% CI 0.84 to 7.02, p = 0.100; adjusted OR for mortality 4.51, 95% CI 2.46 to 8.26, p <0.0001) groups, respectively. Repeat revascularization was similar in all 3 groups at roughly 25%. In conclusion, chronic kidney disease and dialysis were associated with increased major amputations and mortality in patients who received PVI for popliteal and infrapopliteal PAD.
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MESH Headings
- Aged
- Aged, 80 and over
- Amputation, Surgical/statistics & numerical data
- Angioplasty, Balloon
- Angioplasty, Balloon, Laser-Assisted
- Comorbidity
- Constriction, Pathologic/epidemiology
- Constriction, Pathologic/surgery
- Female
- Glomerular Filtration Rate
- Humans
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/therapy
- Male
- Odds Ratio
- Peripheral Arterial Disease/epidemiology
- Peripheral Arterial Disease/surgery
- Popliteal Artery/surgery
- Renal Dialysis
- Renal Insufficiency, Chronic/epidemiology
- Retrospective Studies
- Risk Factors
- Treatment Outcome
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Affiliation(s)
- Kesav C Parvataneni
- Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan.
| | | | - Susan Szpunar
- Department of Medical Education, St. John Hospital and Medical Center, Detroit, Michigan
| | - Tarun Sharma
- Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan
| | - Vishal Patel
- Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan
| | - Saurabhkumar Patel
- Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan
| | - Thomas Davis
- Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan
| | - Thomas Lalonde
- Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan
| | - Hiroshi Yamasaki
- Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan
| | - Howard S Rosman
- Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Matsumi J, Tobita K, Shishido K, Mizuno S, Yamanaka F, Murakami M, Tanaka Y, Takahashi S, Akasaka T, Saito S. Comparison of long-term patency after endovascular therapy for superficial femoral artery occlusive disease between patients with and without hemodialysis. Catheter Cardiovasc Interv 2015; 87:1142-8. [PMID: 26700059 DOI: 10.1002/ccd.26359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/14/2015] [Accepted: 11/22/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare long-term patency after endovascular therapy (EVT) for superficial femoral artery (SFA) occlusive disease between patients with hemodialysis (HD; HD+) and those without HD (HD-). BACKGROUND Long-term patency after EVT for SFA occlusive disease in HD+ remains unknown. METHODS EVT to SFA was successfully performed in 382 consecutive patients during 2004-2011. Cox proportional hazard model estimated the hazard ratio (HR) for the loss of primary patency (PP), secondary patency (SP), and amputation-free survival (AFS) in HD+. Binominal logistic regression analysis calculated the propensity score (PS) for covariates with a P value of <0.2 for HD as a dependent variable. HRs were adjusted for PS in multivariate analysis using the Cox proportional hazard model. RESULTS PP and SP in HD+ and HD- were 47.9 and 79.4% and 68.4 and 92.5%, respectively, 4 years after EVT. There were no procedure-related amputations or in-hospital deaths. Adjusted HRs for the loss of PP, SP, and AFS were as follows: loss of PP, adjusted HR 2.010, 95% CI 1.157-3.492, P = 0.013; loss of SP, adjusted HR 2.927, 95% CI 1.236-6.933, P = 0.015; and loss of AFS, adjusted HR 1.665, 95% CI 0.994-2.791, P = 0.053. CONCLUSIONS Although HD+ had more than double the risks for loss of PP and SP than HD-, EVT to SFA in HD+ was found to be safe with an acceptable PP and SP. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Junya Matsumi
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazuki Tobita
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Koki Shishido
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shingo Mizuno
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masato Murakami
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Saeko Takahashi
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takeshi Akasaka
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
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Rasper M, Wildgruber M, Settles M, Eckstein HH, Zimmermann A, Reeps C, Rummeny EJ, Huber AM. 3D non-contrast-enhanced ECG-gated MR angiography of the lower extremities with dual-source radiofrequency transmission at 3.0 T: Intraindividual comparison with contrast-enhanced MR angiography in PAOD patients. Eur Radiol 2015; 26:2871-80. [DOI: 10.1007/s00330-015-4089-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 08/13/2015] [Accepted: 10/27/2015] [Indexed: 11/25/2022]
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Zhou C, Gong J, Chen D, Wang W, Liu M, Liu B. Levosimendan for Prevention of Acute Kidney Injury After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials. Am J Kidney Dis 2015; 67:408-16. [PMID: 26518388 DOI: 10.1053/j.ajkd.2015.09.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/03/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Levosimendan has been shown to confer direct renoprotection in renal endotoxemic and ischemia-reperfusion injury and could increase renal blood flow in patients with low-cardiac-output heart failure. Results from clinical trials of levosimendan on acute kidney injury (AKI) following cardiac surgery are controversial. STUDY DESIGN A random-effect meta-analysis was conducted based on evidence from PubMed, EMBASE, and Cochrane Library. SETTINGS & POPULATION Adult patients undergoing cardiac surgery. SELECTION CRITERIA FOR STUDIES Randomized controlled trials comparing the renal effect of levosimendan versus placebo or other inotropic drugs during cardiac surgery. INTERVENTION Perioperative levosimendan continuous infusion at a rate of 0.1 to 0.2μg/kg/min following a loading dose (6-24μg/kg) for 24 hours or only 1 loading dose (24μg/kg) within 1 hour. OUTCOMES AKI, need for renal replacement therapy, mechanical ventilation duration, intensive care unit stay during hospitalization, and postoperative mortality (in-hospital or within 30 days). RESULTS 13 trials with a total of 1,345 study patients were selected. Compared with controls, levosimendan reduced the incidence of postoperative AKI (40/460 vs 78/499; OR, 0.51; 95% CI, 0.34-0.76; P=0.001; I(2)=0.0%), renal replacement therapy (22/492 vs 49/491; OR, 0.43; 95% CI, 0.25-0.76; P=0.002; I(2)=0.0%), postoperative mortality (35/658 vs 94/657; OR, 0.41; 95% CI, 0.27-0.62; P<0.001; I(2)=0.0%), mechanical ventilation duration (in days; n=235; weighted mean difference, -0.34; 95% CI, -0.58 to -0.09; P=0.007], and intensive care unit stay (in days; n=500; weighted mean difference, -2.2; 95% CI, -4.21 to -0.13; P=0.04). LIMITATIONS Different definitions for AKI among studies. Small sample size for some trials. CONCLUSIONS Perioperative administration of levosimendan in patients undergoing cardiac surgery may reduce complications. Future trials are needed to determine the dose effect of levosimendan in improving outcomes, especially in patients with decreased baseline kidney function.
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Affiliation(s)
- Chenghui Zhou
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junsong Gong
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Chen
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weipeng Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingzheng Liu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Liu
- Department of Anesthesiology, Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.
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Zargar-Shoshtari K, Ashouri K, Sharma P, Baumgarten A, Sexton WJ, Pow-Sang J, Spiess PE. Nephrectomy and inferior vena cava thrombectomy for renal cell carcinoma among patients with impaired renal function: defining predictors of outcomes. ANZ J Surg 2015; 86:44-8. [PMID: 26370725 DOI: 10.1111/ans.13272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Management of renal cell carcinoma (RCC) with inferior vena cava thrombus (IVCT) is associated with high morbidity. Chronic kidney disease (CKD) is a known risk factor for perioperative complications in many surgical procedures. The objective of this study was to review the association between preoperative CKD (eGFR < 60 mL/min) and post-operative outcomes in patients with RCC and IVCT undergoing radical nephrectomy (RN) and tumour thrombectomy (TT). METHODS A retrospective review of patients with RCC and IVCT treated with RN and TT was carried out. Complications were recorded according to the Clavien-Dindo classification. Multivariable models were fitted using logistic regression analyses for high-grade complications and salvage therapies and linear-regression for intraoperative blood loss (IBL). RESULTS One hundred and one patients with RCC and IVCT, treated with RN and TT, were identified. Forty per cent of patients had preoperative CKD. Median IBL was higher in CKD arm (2.5 versus 1.6 L, P = 0.04). In a multivariate linear regression analysis, CKD (beta 1.34, P = 0.01) remained an independent predictor of IBL. High-grade complications were more frequent in the CKD group (34% versus 16%, P = 0.09) and in logistic regression analysis, CKD was an independent predictor of high-grade complications (OR 3.33, 95% CI 1.01-10.9). Furthermore, CKD patients were less likely to be considered for salvage therapies (62% versus 38%, P = 0.02). CONCLUSIONS In patients treated with RN and TT, CKD is an independent predictor of perioperative morbidity. This clinical variable should be considered when selecting patients and subsequent efforts should be made to optimize other competing risk factors in order to reduce the incidence of perioperative adverse events in this patient population.
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Affiliation(s)
| | - Kenan Ashouri
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Pranav Sharma
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Adam Baumgarten
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Julio Pow-Sang
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Davies MG, El-Sayed HF. Outcomes of Isolated Tibial Endovascular Interventions for Tissue Loss in CLI Patients on Hemodialysis. J Endovasc Ther 2015; 22:681-9. [PMID: 26286072 DOI: 10.1177/1526602815602074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the objective performance goals (OPGs) and patient-centered outcomes of isolated tibial interventions in patients with tissue loss who were on hemodialysis (HD) to patients with tissue loss who were not on HD. METHODS Interrogation of a prospectively maintained database identified 242 critical limb ischemia (CLI) patients who underwent isolated tibial interventions for tissue loss in a single limb between 2007 and 2012. The 78 patients (mean age 66±12 years; 44 men) on HD were compared with 164 patients (mean age 50±13 years; 82 men) who were not on HD. There was an equal distribution of the tibial vessels treated; 152 (63%) patients had more than one treated tibial vessel. Patient-centered outcomes of clinical efficacy (absence of recurrent symptoms, maintenance of ambulation, and no major amputation), amputation-free survival (AFS), and freedom from major adverse limb events (MALE) were evaluated. The Society for Vascular Surgery OPGs were defined at 30 days and 1 year. RESULTS The 30-day major adverse cardiac events was significantly higher (p=0.004) in the HD group (5, 5%) compared with the no-HD group (0%), but both remained under the stated OPG of ≤10%. The 30-day MALE rates were significantly higher than the stated ≤9% OPG at 13% and 18% for the no-HD and HD groups, respectively. At 1 year, the rates for AFS, freedom from MALE, limb salvage, and survival did not achieve the stated Society for Vascular Surgery OPGs in the HD group. Clinical efficacy was 61% and 25% at 3 years for the no-HD and HD groups, respectively (p<0.01). Overall, AFS was 54% and 22% and freedom from MALE was 56% and 27% at 3 years for the no-HD and HD groups, respectively (both p<0.01). CONCLUSION Tibial intervention for tissue loss in patients on HD is a valid treatment option but is associated with a high MALE rate. Three-year outcomes remain relatively poor, with <25% success in terms of clinical efficacy and AFS.
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Affiliation(s)
- Mark G Davies
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, TX, USA
| | - Hosam F El-Sayed
- Division of Vascular Diseases and Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
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Garimella PS, Hirsch AT. Peripheral artery disease and chronic kidney disease: clinical synergy to improve outcomes. Adv Chronic Kidney Dis 2014; 21:460-71. [PMID: 25443571 DOI: 10.1053/j.ackd.2014.07.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 01/07/2023]
Abstract
Persons with CKD are at a higher risk of developing peripheral artery disease (PAD) and its adverse health outcomes than individuals in the general population who have normal renal function. Classic atherosclerosis risk factors (eg, age, smoking, diabetes, hypertension, and hyperlipidemia) are common in patients with CKD, but CKD also imposes additional unique risk factors that promote arterial disease (eg, chronic inflammation, hypoalbuminemia, and a procalcific state). Current nephrology clinical practice is adversely affected by PAD diagnostic challenges, the complexities of managing 2 serious comorbid diseases, delayed vascular specialist referral, and slow PAD treatment initiation in patients with CKD. Persons with CKD are less likely to be provided recommended "optimal" PAD care. The knowledge that both limb and mortality outcomes are significantly worse in patients with CKD, especially those on dialysis, is not just a biologic fact but can serve as a care delivery call to action. Nephrologists can facilitate positive change. This article proposes that patients with PAD and CKD be strategically comanaged by care teams that encompass the skills to create and use evidence-based care pathways. This proposed collaborative multidisciplinary approach will include vascular medicine specialists, nephrologists, wound specialists, and mid-level providers. Just as clinical care quality metrics have served as the base for ESRD and acute MI quality improvement, it is time that such quality outcomes metrics be initiated for the large PAD-CKD population. This new system will identify and resolve key gaps in the current care model so that clinical outcomes improve within a cost-effective care frame for this vulnerable population.
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Squires MH, Lad NL, Fisher SB, Kooby DA, Weber SM, Brinkman A, Scoggins CR, Egger ME, Cardona K, Cho CS, Martin RCG, Russell MC, Winslow E, Staley CA, Maithel SK. The effect of preoperative renal insufficiency on postoperative outcomes after major hepatectomy: a multi-institutional analysis of 1,170 patients. J Am Coll Surg 2014; 219:914-22. [PMID: 25260685 DOI: 10.1016/j.jamcollsurg.2014.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Renal insufficiency adversely affects outcomes after cardiac and vascular surgery. The effect of preoperative renal insufficiency on outcomes after major hepatectomy is unknown. STUDY DESIGN All patients who underwent major hepatectomy (≥3 segments) at 3 institutions from 2000 to 2012 were identified. Resections were performed using low central venous pressure anesthesia. Renal function was analyzed by preoperative serum creatinine (sCr) level. Primary outcomes were major complications (Clavien grade III to V), respiratory failure, renal failure requiring hemodialysis, and 90-day mortality. RESULTS One thousand one hundred and seventy patients had preoperative sCr levels available. Renal function was analyzed using sCr dichotomized at 1.8 mg/dL, 1 SD higher than the mean value (0.97 ± 0.79 mg/dL) for the cohort. Twenty-two patients had sCr ≥1.8 mg/dL. Major complications occurred in 279 patients (23.8%), respiratory failure in 62 (5.3%), and renal failure in 31 (2.6%). Ninety-day mortality rate was 5.4%. On multivariate analysis, patients with sCr ≥1.8 mg/dL remained at significantly increased risk for major complications (hazard ratio = 3.94; 95% CI, 1.48-10.49; p = 0.006), respiratory failure (hazard ratio = 4.43; 95% CI, 1.33-14.80; p = 0.014), and renal failure (hazard ratio = 4.75; 95% CI, 1.19-18.97; p = 0.028). Serum Cr ≥1.8 mg/dL was not independently associated with 90-day mortality on multivariate analysis (p = 0.27). CONCLUSIONS Preoperative serum creatinine ≥1.8 mg/dL identifies patients at significantly increased risk of postoperative major complications, respiratory failure, and renal failure requiring dialysis. Patients are well selected for major hepatectomy, and few patients with substantial renal insufficiency are deemed operative candidates.
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Affiliation(s)
- Malcolm H Squires
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Neha L Lad
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Sarah B Fisher
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - David A Kooby
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Adam Brinkman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Charles R Scoggins
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
| | - Michael E Egger
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
| | - Kenneth Cardona
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Clifford S Cho
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Robert C G Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
| | - Maria C Russell
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Emily Winslow
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Charles A Staley
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shishir K Maithel
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
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Squires MH, Mehta VV, Fisher SB, Lad NL, Kooby DA, Sarmiento JM, Cardona K, Russell MC, Staley CA, Maithel SK. Effect of preoperative renal insufficiency on postoperative outcomes after pancreatic resection: a single institution experience of 1,061 consecutive patients. J Am Coll Surg 2014; 218:92-101. [PMID: 24211054 PMCID: PMC6002849 DOI: 10.1016/j.jamcollsurg.2013.09.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is known to adversely affect cardiac and vascular surgery outcomes. We examined the effect of preoperative renal insufficiency on postoperative outcomes after pancreatic resection. STUDY DESIGN All patients who underwent pancreatic resection between January 2005 and July 2012 were identified. Glomerular filtration rate (eGFR) was estimated by the Modification of Diet in Renal Disease formula. Severe CKD (stages 4-5) was defined as eGFR < 30 mL/min/1.73 m(2). Renal function also was analyzed using serum creatinine (sCr) dichotomized at 1.8 mg/dL. Primary outcomes were any complication, major complications, and respiratory failure. Multivariate models for each endpoint were constructed by including all variables with p value ≤ 0.10 on univariate analysis. RESULTS There were 1,061 patients identified; 709 underwent pancreaticoduodenectomy, 307 distal pancreatectomy, and 45 central or total pancreatectomy. Median sCr value was 0.86 mg/dL (range 0.30 to 14.1 mg/dL). Eighteen patients (1.7%) had severe CKD and 31 (2.9%) had sCr ≥ 1.8 mg/dL. Complications occurred in 622 patients (58.6%), major complications in 198 (18.7%), and respiratory failure in 48 (4.5%). Both severe CKD and sCr ≥ 1.8 mg/dL were associated with any complication, major complications, and respiratory failure on univariate analysis. On multivariate analysis, severe CKD was associated with increased complications (odds ratio [OR] 5.5; 95% CI 1.3 to 25.5; p = 0.02) and respiratory failure (OR 6.1; 95% CI 1.8 to 20.5; p = 0.03), but not major complications. Using sCr ≥ 1.8 mg/dL as a surrogate marker for renal insufficiency, patients with sCr ≥ 1.8 mg/dL had increased risk of any complication (OR 3.5; 95% CI 1.3 to 9.3; p = 0.01), major complications (OR 2.2; 95% CI 1.04 to 4.8; p = 0.04), and respiratory failure (OR 4.7; 95% CI 1.8 to 12.6; p = 0.002). CONCLUSIONS Few patients with significant renal insufficiency are candidates for pancreatic resection. Severe CKD (stages 4-5) is associated with increased risk of complication and respiratory failure. Serum creatinine ≥ 1.8 mg/dL may serve as a useful marker of renal insufficiency and identifies patients at significantly increased risk of any complication, major complication, and respiratory failure after pancreatic resection.
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Affiliation(s)
- Malcolm H Squires
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Vishes V Mehta
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Sarah B Fisher
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Neha L Lad
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - David A Kooby
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Juan M Sarmiento
- Division of General and GI Surgery, Emory University, Atlanta, GA
| | - Kenneth Cardona
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Maria C Russell
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Charles A Staley
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shishir K Maithel
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
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Chang SH, Tsai YJ, Chou HH, Wu TY, Hsieh CA, Cheng ST, Huang HL. Clinical Predictors of Long-Term Outcomes in Patients With Critical Limb Ischemia Who have Undergone Endovascular Therapy. Angiology 2013; 65:315-22. [DOI: 10.1177/0003319713515544] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical predictors of long-term outcomes in patients with critical limb ischemia (CLI) treated with endovascular therapy (EVT) remain unclear. In this study, clinical predictors of long-term outcomes in EVT-treated patients with CLI were investigated. In this prospective, observational study, we analyzed a total of 253 Taiwanese patients with CLI with 314 limbs who underwent EVT between 2005 and 2012. Cox models were used to estimate hazard ratios of death, limb loss, and sustained clinical success (SCS). Multivariate analysis showed that age, atrial fibrillation (AF), end-stage renal disease (ESRD), and albumin were significant predictors of mortality. Patients with coronary artery disease and low albumin levels had a significant risk of major limb amputation, while AF, ESRD, and albumin were significant, independent predictors of SCS. In addition to previously reported predictors, we showed that AF and malnutrition can be used to predict long-term outcome in EVT-treated patients with CLI.
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Affiliation(s)
- Shang-Hung Chang
- Section of Cardiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yueh-Ju Tsai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Hua Chou
- Department of Internal Medicine, Section of Cardiology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan
| | - Tien-Yu Wu
- Department of Internal Medicine, Section of Cardiology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan
| | - Chien-An Hsieh
- Department of Internal Medicine, Section of Cardiology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan
| | - Shih-Tsung Cheng
- Department of Internal Medicine, Section of Cardiology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan
| | - Hsuan-Li Huang
- Department of Internal Medicine, Section of Cardiology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan
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Abstract
Chronic kidney disease (CKD) is a major public health problem worldwide. Roughly 1 in 10 adult Americans has CKD. These patients are at significant risk for excessive morbidity and mortality during the perioperative period. Given the health and cost burden of end-stage renal disease (ESRD), preventing or avoiding progression of CKD to ESRD is critical. Therefore, identifying risk factors and implementing risk mitigation strategies to prevent further deterioration of renal function during the perioperative period is of paramount importance. This article reviews patient risk stratification, preoperative evaluation and management, and perioperative interventions for renal protection.
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Affiliation(s)
- Alicia Gruber Kalamas
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, PO Box 0648, San Francisco, CA 94143-0648, USA.
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Adalbert S, Adelina M, Romulus T, Flaviu Raul B, Bogdan T, Raluca B, Mihai I. Acute kidney injury in peripheral arterial surgery patients: a cohort study. Ren Fail 2013; 35:1236-9. [PMID: 23924285 DOI: 10.3109/0886022x.2013.823830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of the study was to evaluate the prevalence of acute kidney injury (AKI) in a cohort of surgically treated patients with peripheral artery disease (PAD) and its association with the short-term and long-term outcome. MATERIALS AND METHODS We conducted a retrospective cohort study on all the consecutive PAD inpatients in 2008. Data on the patients' demographic characteristics, medical history, treatment, outcome and laboratory tests measurements were retrieved from the medical records. RESULTS We analyzed 166 patients (71.6% males, mean age 63.2 years ± SD 10.7 years) and found an AKI prevalence of 12.7%. The AKI patients' group had more chronic kidney disease (CKD) (23.8% vs. 6.2%, p = 0.005), diabetes mellitus (DM) (61.9% vs. 33.1%, p = 0.011) and a higher length of hospital stay (19.48 vs. 15.42 days, p = 0.047). At one year, the mortality was 33.3% in the AKI group compared to 1.3% in non-AKI group, with a strong association between AKI and death (OR = 35.7; 95%CI = 6.7 to 189) and AKI and major cardiovascular events (OR = 29.1; 95% CI = 6.8 to 123.4). There was no significant difference in terms of age, cardiovascular disease and medication between the two groups. CONCLUSIONS AKI was associated with a poorer one-year outcome after the surgery of PAD patients. In our study, the presence of previous chronic kidney disease and type 2 diabetes increased the incidence of acute kidney injury after surgery.
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Cross-sectional and Case-Control Analyses of the Association of Kidney Function Staging With Adverse Postoperative Outcomes in General and Vascular Surgery. Ann Surg 2013; 258:169-77. [DOI: 10.1097/sla.0b013e318288e18e] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mooney JF, Ranasinghe I, Chow CK, Perkovic V, Barzi F, Zoungas S, Holzmann MJ, Welten GM, Biancari F, Wu VC, Tan TC, Cass A, Hillis GS. Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: a systematic review and meta-analysis. Anesthesiology 2013; 118:809-24. [PMID: 23377223 DOI: 10.1097/aln.0b013e318287b72c] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Kidney dysfunction is a strong determinant of prognosis in many settings. METHODS A systematic review and meta-analysis was undertaken to explore the relationship between estimated glomerular filtration rate (eGFR) and adverse outcomes after surgery. Cohort studies reporting the relationship between eGFR and major outcomes, including all-cause mortality, major adverse cardiovascular events, and acute kidney injury after cardiac or noncardiac surgery, were included. RESULTS Forty-six studies were included, of which 44 focused exclusively on cardiac and vascular surgery. Within 30 days of surgery, eGFR less than 60 m l · min · 1.73 m(-2) was associated with a threefold increased risk of death (multivariable adjusted relative risk [RR] 2.98; 95% confidence interval [CI] 1.95-4.96) and acute kidney injury (adjusted RR 3.13; 95% CI 2.22-4.41). An eGFR less than 60 ml · min · 1.73(-2) m was associated with an increased risk of all-cause mortality (adjusted RR 1.61; 95% CI 1.38-1.87) and major adverse cardiovascular events (adjusted RR 1.49; 95% CI 1.32-1.67) during long-term follow-up. There was a nonlinear association between eGFR and the risk of early mortality such that, compared with patients having an eGFR more than 90 ml · min · 1.73m(-2) the pooled RR for death at 30 days in those with an eGFR between 30 and 60 ml · min · 1.73 m(-2) was 1.62 (95% CI 1.43-1.80), rising to 2.85 (95% CI 2.49-3.27) in patients with an eGFR less than 30 ml · min · 1.73 m(-2) and 3.75 (95% CI 3.44-4.08) in those with an eGFR less than 15 ml · min · 1.73 m(-2). CONCLUSION : There is a powerful relationship between eGFR, and both short- and long-term prognosis after, predominantly cardiac and vascular, surgery.
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Affiliation(s)
- John F Mooney
- The George Institute for Global Health, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050 Australia.
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Valoración preanestésica en el paciente con enfermedad renal crónica (énfasis en riesgo cardiovascular). ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.rca.2013.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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González Cárdenas VH, Vargas JG, Echeverri JE, Díaz SM, Mena Méndez Y. Pre-anesthesia evaluation in patients with chronic renal disease (emphasis on cardiovascular risk). COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2013.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Nishimura H, Enokida H, Tsuruta M, Yoshino Y, Yamada Y, Sugita S, Hayashi S, Arata K, Hayami H, Nishiyama K, Nakagawa M. Combination treatment using percutaneous transluminal angioplasty and low-density lipoprotein apheresis in a patient with peripheral arterial disease and a history of chronic hemodialysis. J Clin Apher 2013; 28:330-4. [DOI: 10.1002/jca.21273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 02/04/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Hiroaki Nishimura
- Department of Urology; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
| | - Hideki Enokida
- Department of Urology; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
| | - Masafumi Tsuruta
- Department of Urology; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
| | - Yuji Yoshino
- Department of Urology; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
| | - Yasutoshi Yamada
- Department of Urology; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
| | - Satoshi Sugita
- Department of Urology; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
| | - Sadao Hayashi
- Department of Radiology; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
| | - Kenichi Arata
- Second Department of Surgery; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
| | - Hiroshi Hayami
- Department of Urology; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
| | - Kenryu Nishiyama
- Department of Urology; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
| | - Masayuki Nakagawa
- Department of Urology; Graduate School of Medical and Dental Sciences, Kagoshima University; Kagoshima; Japan
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Pre-anesthesia evaluation in patients with chronic renal disease (emphasis on cardiovascular risk)☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1097/01819236-201341020-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lewis S, Raj D, Guzman NJ. Renal failure: implications of chronic kidney disease in the management of the diabetic foot. Semin Vasc Surg 2012; 25:82-8. [PMID: 22817857 DOI: 10.1053/j.semvascsurg.2012.04.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Foot complications are common in patients with diabetes, however, chronic kidney disease has emerged as an independent risk factor for development of foot lesions in the diabetic population. Apart from peripheral arterial disease, infection, and neuropathy, which are classic factors contributing to development of foot lesions, skin disorders specific to renal failure, impaired wound healing from uremia, and psychosocial issues offer further compounded risk. Consequently, there are high ulceration and amputation rates that are associated with increased morbidity and mortality. In recent studies, foot-care programs with a multidisciplinary approach within dialysis units have demonstrated improved outcomes.
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Affiliation(s)
- Shari Lewis
- Division of Renal Diseases and Hypertension, Medical Faculty Associates, The George Washington University School of Medicine, Washington, DC 20037, USA
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Yevzlin AS, Gimelli G. Diagnosis and treatment of peripheral arterial disease in CKD patients. Semin Dial 2012; 26:240-51. [PMID: 23067047 DOI: 10.1111/sdi.12001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Peripheral arterial disease (PAD) is a cardiovascular disease risk equivalent and is a common problem in chronic kidney disease patients. Unlike in the general population, PAD in CKD occurs due to medial calcification as opposed to intimal atherosclerotic process. PAD intervention should be performed in select symptomatic patients, as described by the guidelines, and CVD risk factor modification should occur in all CKD patient, regardless of the presence of PAD. As a discipline, Interventional Nephrology has emerged out of a desire to create better outcomes for our patients and to "fix a problem." The core values of our discipline have evolved out of this fundamental desire to meet an unmet clinical need, to provide insight into a disease state specific to our patients, and to offer clinical/academic excellence in doing so. We must endeavor to follow a similar path in our approach to PAD. The purpose of this review is to educate interventional nephrologists in the diagnosis and treatment of PAD in their CKD patients.
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Affiliation(s)
- Alexander S Yevzlin
- Department of Medicine, Nephrology and Cardiovascular Medicine Sections, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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