Rates of Future Hemodialysis Risk and Beneficial Outcomes for Patients with Chronic Kidney Disease Undergoing Recanalization of Chronic Total Occlusion

Abstract Background This study aimed to assess the prognosis and deleterious effects of chronic kidney disease (CKD) on future renal function, in patients who had undergone chronic total occlusion-percutaneous coronary intervention (CTO-PCI). Methods The treatment effects were studied in 739 patients who underwent CTO-PCI. The patients were divided into 3 groups according to estimated glomerular filtration rate (eGFR): non-CKD (eGFR ≥ 60 ml/min/1.73m2 , n = 562), CKD-1 (45 ≤ eGFR < 60 ml/min/1.73m2 , n = 90), and CKD-2 (eGFR < 45 ml/min/1.73m2 , n = 87). Future hemodialysis (HD) rates and the prevalence of acute kidney injury (AKI) except for 45 patients undergoing regular HD, and other clinical and prognostic outcomes were compared between the 3 groups. Results Procedural success rates showed trends toward lower prevalence across the 3 groups (89.5%, 84.4%, and 81.6%, p = 0.060). The prevalence of AKI significantly differed between the 3 groups (4.6%, 8.9%, and 16.7%, p = 0.001), whereas no patients were introduced to regular HD at discharge. During a median follow-up period of 51.2 ± 28.9 months, newly required HD significantly differed between the 3 groups (0.7%, 0%, and 7.1%, p < 0.001). When compared with unsuccessful CTO-PCI, successful CTO-PCI was found to improve cardiovascular mortality in the non-CKD and CKD-1 (Log-rank test: p = 0.025, p = 0.024, respectively) and to improve both cardiovascular and all-cause mortality in the CKD-2 (Log-rank test: p = 0.027, p = 0.0022, respectively). Conclusions Although CTO-PCI for patients with advanced CKD was associated with a high risk of future HD introduction, not directly owing to CTO-PCI and AKI, successful treatment of CTO might contribute to better survival benefit regardless of the presence or absence of CKD.