Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease

Purpose To evaluate effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE and postoperative death (MALE + POD), and amputation after endovascular treatment of femoropopliteal disease. Materials and Methods A retrospective review from January 2002 to October 2011 was performed of 440 patients who underwent endovascular treatment of symptomatic femoropopliteal disease for claudication (n = 251) or critical limb ischemia (CLI) (n = 267). CKD stage was divided based on Kidney Dialysis Outcomes Quality Initiative classification. Outcomes and factors associated with amputation, MALE, and MALE + POD were determined. Results Patients with diabetes (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.3–3.6; P =.002) and runoff score of 0 or 1 (HR = 2.0; 95% CI, 1.2–3.4; P =.01) relative to runoff score of 3 were at increased risk of amputation. Patients with baseline glomerular filtration rate < 45 mL/min/1.73 m² had a 17% increase in amputation for every 5-point decrease < 45 mL/min/1.73 m² (95% CI, 1.09–1.26; P <.001). Increase of 10 years in age (HR = 1.9; 95% CI, 1.5–2.3; P <.001), TransAtlantic Inter-Society Consensus class of C/D relative to A/B (HR = 1.6; 95% CI, 1.1–2.2; P =.01), and CLI (HR = 2.4; 95% CI, 0.5–0.9; P <.001) were associated with increased mortality. Female sex was associated with decreased risk of mortality (HR = 0.7; 95% CI, 0.5–0.9; P =.01). Conclusions Worsening CKD is associated with higher amputation rates, all-cause mortality, and MALE + POD in patients undergoing endovascular treatment of femoropopliteal disease.