Characteristics and Outcomes of Patients with Chronic Kidney Disease Undergoing Peripheral Vascular Interventions for Symptomatic Lower Extremity Peripheral Artery Disease

Narcisse, Dennis

Characteristics and Outcomes of Patients with Chronic Kidney Disease Undergoing Peripheral Vascular Interventions for Symptomatic Lower Extremity Peripheral Artery Disease

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Jennifer A Rymer, MD, MBA , Duke Clinical Research Institute, Durham, NC

Brad J Martinsen, PhD , Cardiovascular Systems Inc, St. Paul, MN

Dennis I Narcisse, MD , Duke University Medical Center, Durham, NC

Ryan Bolduan, BA , Cardiovascular Systems Inc, St. Paul, MN

Michael R. Jaff, D.O. , Newton-Wellesley Hospital, Chestnut Hill, MA

William Anthony Gray, M.D., FSCAI , Lankernau Medical Center, Wynnewood, PA

Jihad A. Mustapha, M.D., FSCAI , Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, MI

George L. Adams, MD, MHS , North Carolina Heart and Vascular Associates, Wake Forest, NC

Gary M. Ansel, M.D., FSCAI , OhioHealth Heart & Vascular Physicians, Columbus, OH

Manesh R. Patel, M.D., FSCAI , Duke University Medical Center, Durham, NC

William Schuyler Jones, M.D. , Duke University Medical Center, Durham, NC

Background
Patients with chronic kidney disease (CKD) and peripheral artery disease (PAD) are at risk of cardiovascular and limb events. There is little data on patients with PAD and CKD who undergo peripheral vascular intervention (PVI).

Methods
Using data from LIBERTY 360° trial, a prospective,multicenter trial evaluating outcomes after PVI in patients with PAD, we compared baseline characteristics of patients with and without a history of CKD. We compared the unadjusted 30-day and 1-year major adverse events (MAE), as well as the 1-year change in the Vascular Quality of Life (VascuQOL) survey score, between the groups.

Results
Among 1,189 patients enrolled in LIBERTY 360°, 31.8% had a history of CKD. As compared with patients without CKD, CKD patients had similar age (mean 70.6 vs. 69.5 yrs), but were more likely black (18.3% vs. 13.4%) with diabetes (72.0% vs. 56.1%), p<0.05 for both. The average eGFR was 36.6 vs. 75.6 mL/min(CKD vs. no CKD). CKD patients were more likely to have a MAE (Figure) or major amputation event at 30 days [HR 3.27 (95% CI 1.66-6.43) for MAE; HR 3.78 (95% CI 1.11-12.92) for major amputation] and 1 year [HR 1.47 (95% CI 1.17-1.84); HR 2.24 (95% CI 1.21-4.17)] vs. patients without CKD. There was no difference in TVR at 30 days or 1 year for CKD vs. patients without CKD. There was no change in VascuQOL activity and physical subdomain scores at 1 year in patients with CKD vs. without CKD.

Conclusions
CKD patients are at greater risk for MAE and major amputation after PVI for PAD without a significant change in QOL at 1 year. Further work will be needed to determine how to mitigate cardiovascular risks in this vulnerable population.