Abstract 343: Chronic Kidney Disease is associated with Increased Mortality among Patients Undergoing Peripheral Vascular Intervention

Background: Among patients with peripheral vascular disease (PVD) undergoing surgical revascularization, chronic kidney disease (CKD) is associated with increased postoperative morbidity and mortality. However, the impact of CKD on adverse outcomes among PVD patients undergoing peripheral vascular interventions (PVI) is less well established. Methods: Using data from the VA Clinical Assessment, Reporting, and Tracking System (CART) Program, we identified a cohort of patients who received PVI between June 2005 and August 2010 at 33 sites. Excluding patients requiring chronic dialysis, the presence of CKD was defined based on baseline GFR of less than 60 mL/min/1.73 m2 obtained within 30 days prior to the procedure. The outcomes of interest were mortality, progression of CKD to dialysis, myocardial infarction (MI), and limb amputation. Multivariable Cox Proportional Hazards model assessed the association between CKD and adverse outcomes. Results: Of 784 patients undergoing PVI, 203 (26%) patients had CKD, 27 (3%) patients were on dialysis and 554 (71%) patients did not have CKD. Patients with CKD were older, and were more likely to have diabetes and CHF. On Kaplan-Meier analysis, CKD was associated with decreased survival (5-year survival probability of CKD compared to non-CKD: 53.7% (44.5%-61.9%) versus 79.3% (74.8%-83.1%), P<0.01) (Figure), which persisted after risk adjustment (HR 1.40; 1.07-1.83). In addition, CKD patients were more likely to have progression to dialysis (HR 6.30; 3.37-11.79). In contrast, there were no significant differences for the outcomes of MI (HR 1.04; 0.47-2.31) or limb amputation (HR 0.90; 0.57-1.44). Conclusion: CKD is present among 1 in 4 patients undergoing PVI. CKD is associated with increased risk of mortality and progression to dialysis; however, there is no significant association with MI or limb amputation. Future studies are needed to assess whether there are opportunities to modify the risks associated with CKD among patients undergoing PVI. ![][1] [1]: /embed/graphic-1.gif