PMID- 37191239
OWN - NLM
STAT- Publisher
LR  - 20230516
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
DP  - 2023 May 16
TI  - Acute Kidney Injury Following Revascularization in Patients With Chronic 
      Limb-Threatening Ischemia and Non-Dialysis-Dependent Chronic Kidney Disease: 
      Insights From the NSQIP Database at 30-Day Follow-Up.
PG  - 15266028231173297
LID - 10.1177/15266028231173297 [doi]
AB  - BACKGROUND: Patients with chronic limb-threatening ischemia (CLTI) and chronic 
      kidney disease (CKD) are at risk of developing renal injury following 
      revascularization. We aimed to compare the risk of adverse renal events following 
      endovascular revascularization (ER) or open surgery (OS) in patients with CLTI 
      and CKD. METHODS: A retrospective analysis of the National Surgical Quality 
      Improvement Program (NSQIP) databases (2011-2017) was performed including 
      patients with CLTI and non-dialysis-dependent CKD, comparing ER to OS. The 
      primary outcome was a composite of postprocedural kidney injury or failure within 
      30 days. Thirty-day mortality, major adverse cardiac and cerebrovascular events 
      (MACCE), amputation, readmission or target lesion revascularization (TLR) were 
      compared using multivariate logistic regression and propensity-score matched 
      analysis. RESULTS: A total of 5009 patients were included (ER: 2361; OS: 3409). 
      The risk for the composite primary outcome was comparable between groups (odds 
      ratio [OR]: 0.78, 95% confidence interval (CI): 0.53-1.17) as for kidney injury 
      (n=54, OR: 0.97, 95% CI: 0.39-1.19) or failure (n=55, OR: 0.68, 95% CI: 
      0.39-1.19). In the adjusted regression, a significant benefit was observed with 
      ER for the primary outcome (OR: 0.60, p=0.018) and renal failure (OR: 0.50, 
      p=0.025), but not for renal injury (OR: 0.76, p=0.34). Lower rates of MACCE, TLR, 
      and readmissions were observed after ER. Thirty-day mortality and major 
      amputation rates did not differ. In the propensity score analysis, 
      revascularization strategy was not associated with renal injury or failure. 
      CONCLUSIONS: In this cohort, the incidence of renal events within 30 days of 
      revascularization in CLTI was low and comparable between ER and OR. CLINICAL 
      IMPACT: In a cohort of 5009 patients with chronic limb-threatening ischemia and 
      non-end-stage chronic kidney disease (CKD), postprocedural kidney injury or 
      failure within 30 days was comparable between patients submitted to open or 
      endovascular revascularization (ER). Lower rates of major adverse cardiac and 
      cerebrovascular events, target lesion revascularization, and readmissions were 
      observed after endovascular revascularization. Based on these findings, ER should 
      not be avoided due to fear of worsening renal function in CKD patients with 
      chronic limb-threatening ischemia. In fact, these patients benefit more from ER 
      regarding cardiovascular outcomes with no increased risk of kidney injury.
FAU - Stavroulakis, Konstantinos
AU  - Stavroulakis K
AUID- ORCID: 0000-0002-9775-9210
AD  - Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, 
      Germany.
FAU - Tsilimparis, Nikolaos
AU  - Tsilimparis N
AD  - Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, 
      Germany.
FAU - Saratzis, Athanasios
AU  - Saratzis A
AD  - Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
FAU - Rantner, Barbara
AU  - Rantner B
AD  - Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, 
      Germany.
FAU - Stana, Jan
AU  - Stana J
AUID- ORCID: 0000-0002-0013-7870
AD  - Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, 
      Germany.
FAU - Dayama, Anand
AU  - Dayama A
AD  - Division of Vascular and Endovascular Surgery, The University of Texas Health 
      Science Center at San Antonio, San Antonio, TX, USA.
FAU - Davies, Mark G
AU  - Davies MG
AD  - Division of Vascular and Endovascular Surgery, The University of Texas Health 
      Science Center at San Antonio, San Antonio, TX, USA.
FAU - Gouveia E Melo, Ryan
AU  - Gouveia E Melo R
AUID- ORCID: 0000-0001-8327-6384
AD  - Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, 
      Germany.
LA  - eng
PT  - Journal Article
DEP - 20230516
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
OTO - NOTNLM
OT  - NSQIP
OT  - chronic limb-threatening ischemia
OT  - endovascular revascularization
OT  - kidney outcomes
OT  - open revascularization
EDAT- 2023/05/16 13:09
MHDA- 2023/05/16 13:09
CRDT- 2023/05/16 07:33
PHST- 2023/05/16 13:09 [medline]
PHST- 2023/05/16 13:09 [pubmed]
PHST- 2023/05/16 07:33 [entrez]
AID - 10.1177/15266028231173297 [doi]
PST - aheadofprint
SO  - J Endovasc Ther. 2023 May 16:15266028231173297. doi: 10.1177/15266028231173297.