학술논문
Peripheral arterial disease in hemodialysis patients 10 years later.
Document Type
Academic Journal
Author
Rojas ÁG; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: Angela.gonzaro@gmail.com.; Martínez AV; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Benítez PR; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Estébanez SA; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Moreno EV; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Barrios AA; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; de Pablo JCL; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; de Morales AM; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Antonova AM; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Colombina AB; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Ávila CMC; Cirugia Vascular Periférica, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Gómez JR; Cirugia Vascular Periférica, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Ramos ML; Cirugia Vascular Periférica, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Diezhandino MG; Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Source
Publisher: Elsevier España, Place of publication not identified Country of Publication: Spain NLM ID: 101778581 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2013-2514 (Electronic) Linking ISSN: 20132514 NLM ISO Abbreviation: Nefrologia (Engl Ed) Subsets: MEDLINE
Subject
Language
English
Abstract
Background and Objective: Patients with chronic kidney disease (CKD) on hemodialysis present high cardiovascular comorbidity. Peripheral arterial disease (PAD) is associated with higher mortality and the interest in its early detection and treatment is increasing. The objective of this study is to determine the frequency and severity of symptomatic PAD, and to establish its relationship with mortality in HD patients that have received treated early and compare them with a cohort of our center already reported.
Material and Methods: Retrospective study on a cohort of incident patients since 2014 and followed up until December 2019. Demographic data, cardiovascular risk, the presence of symptomatic PAD at baseline and during follow-up were collected. Trophic lesions were graded using the Rutherford scale.
Results: Initially, there were 91 patients and 7 cases that were not included in the study were lost to follow-up. Age 64 ± 16 years, men 51.6% (47/91). The percentage of baseline PAD was 10.7% (9/84). During a median follow-up of 35 months (20-57), the diagnosis of PAD increased to 25% (21/84). Half of the patients with PAD 52.38% (11/21) obtained a score greater than 3 in the Rutherford Clinical Classification, which corresponds to severe disease. 13/21 patients required reoperation due to recurrence of symptoms (61.9% of cases with PAD). The development of PAD was significantly associated with: an elevated index of Charlson (3.9±2.1 vs. 7.7 ± 3.5; P = 0.001),being male (19 vs. 2; P = 0.001), diabetic (no: 7; yes: 15; P = 0.001) and with a history of chronic ischemic heart disease (no: 13; yes: 8; P = 0.001), 38.1% (8/21) had ischemic heart disease in patients who developed PAD, while in the absence of PAD the presence of ischemic heart disease was 9.5% (6/63). Furthermore, more than half (66.7% [14/21]) of those who developed PAD were diabetic. Univariate analysis showed that age, C reactive protein, albumin, and number of surgical interventions, but not PAD, were associated with mortality. In the multivariate analysis adjusted for other factors, only C reactive protein was related to overall survival Exp β: 2.17; P = 0.011; CI (1.19-3.97). Regarding cardiovascular mortality, in the multivariate Cox analysis, only PAD was related to mortality of cardiovascular origin Exp β: 1.73; P = 0.006; CI (1.17-2.56).
Conclusions: A significant number of patients on hemodialysis develop PAD requiring peripheral vascular surgery. PAD was not associated with overall mortality in our cohort, but it did show an association with cardiovascular mortality. Prospective studies with a larger sample size are necessary. New surgical treatments and Follow-up by vascular surgeons could improve the severity of PAD and the long-term prognosis.
(Copyright © 2022 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
Material and Methods: Retrospective study on a cohort of incident patients since 2014 and followed up until December 2019. Demographic data, cardiovascular risk, the presence of symptomatic PAD at baseline and during follow-up were collected. Trophic lesions were graded using the Rutherford scale.
Results: Initially, there were 91 patients and 7 cases that were not included in the study were lost to follow-up. Age 64 ± 16 years, men 51.6% (47/91). The percentage of baseline PAD was 10.7% (9/84). During a median follow-up of 35 months (20-57), the diagnosis of PAD increased to 25% (21/84). Half of the patients with PAD 52.38% (11/21) obtained a score greater than 3 in the Rutherford Clinical Classification, which corresponds to severe disease. 13/21 patients required reoperation due to recurrence of symptoms (61.9% of cases with PAD). The development of PAD was significantly associated with: an elevated index of Charlson (3.9±2.1 vs. 7.7 ± 3.5; P = 0.001),being male (19 vs. 2; P = 0.001), diabetic (no: 7; yes: 15; P = 0.001) and with a history of chronic ischemic heart disease (no: 13; yes: 8; P = 0.001), 38.1% (8/21) had ischemic heart disease in patients who developed PAD, while in the absence of PAD the presence of ischemic heart disease was 9.5% (6/63). Furthermore, more than half (66.7% [14/21]) of those who developed PAD were diabetic. Univariate analysis showed that age, C reactive protein, albumin, and number of surgical interventions, but not PAD, were associated with mortality. In the multivariate analysis adjusted for other factors, only C reactive protein was related to overall survival Exp β: 2.17; P = 0.011; CI (1.19-3.97). Regarding cardiovascular mortality, in the multivariate Cox analysis, only PAD was related to mortality of cardiovascular origin Exp β: 1.73; P = 0.006; CI (1.17-2.56).
Conclusions: A significant number of patients on hemodialysis develop PAD requiring peripheral vascular surgery. PAD was not associated with overall mortality in our cohort, but it did show an association with cardiovascular mortality. Prospective studies with a larger sample size are necessary. New surgical treatments and Follow-up by vascular surgeons could improve the severity of PAD and the long-term prognosis.
(Copyright © 2022 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)