CKD and Acute and Long-Term Outcome of Patients with Peripheral Artery Disease and Critical Limb Ischemia
Despite the many studies showing an association between CKD and a high risk of ischemic events and mortality, the association of CKD with peripheral arterial disease (PAD) still has not been well described. This large cohort study assessed the association of CKD, even in the earlier stages, with mor...
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| Veröffentlicht in: | Clinical journal of the American Society of Nephrology 2016-02, Vol.11 (2), p.216-222 |
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| creator | Lüders, Florian Bunzemeier, Holger Engelbertz, Christiane Malyar, Nasser M Meyborg, Matthias Roeder, Norbert Berger, Klaus Reinecke, Holger |
| description | Despite the many studies showing an association between CKD and a high risk of ischemic events and mortality, the association of CKD with peripheral arterial disease (PAD) still has not been well described.
This large cohort study assessed the association of CKD, even in the earlier stages, with morbidity, short- and long-term outcome, and costs among patients with PAD.
We identified 41,882 patients with PAD who had an index hospitalization between January 1, 2009, and December 31, 2011. Of these, 8470 (20.2%) also had CKD (CKD stage 2: n=2158 [26%]; stage 3: n=3941 [47%]; stage 4: n=935 [11%]; stage 5: n=1436 [17%]). The ratio of women to men was 1:1.2. Compared with patients without known CKD, those with CKD had higher frequencies of coronary artery disease (1.8-fold higher; P |
| doi_str_mv | 10.2215/CJN.05600515 |
| format | Article |
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This large cohort study assessed the association of CKD, even in the earlier stages, with morbidity, short- and long-term outcome, and costs among patients with PAD.
We identified 41,882 patients with PAD who had an index hospitalization between January 1, 2009, and December 31, 2011. Of these, 8470 (20.2%) also had CKD (CKD stage 2: n=2158 [26%]; stage 3: n=3941 [47%]; stage 4: n=935 [11%]; stage 5: n=1436 [17%]). The ratio of women to men was 1:1.2. Compared with patients without known CKD, those with CKD had higher frequencies of coronary artery disease (1.8-fold higher; P<0.001), chronic heart failure (3.3-fold higher; P<0.001), and Rutherford PAD categories 5 and 6 (1.8-fold higher; P<0.001); underwent significantly fewer revascularizations (0.9-fold fewer; P<0.001); had a nearly two-fold higher amputation rate (P<0.001); had higher frequencies of in-hospital infections (2.1-fold higher; P<0.001), acute renal failure (2.8-fold higher; P<0.001), and sepsis (1.9-fold higher; P<0.001); had a 2.5-fold higher frequency of myocardial infarction (P<0.001); and had a nearly three-fold higher in-hospital mortality rate (P<0.001). In an adjusted multivariable Cox regression model, CKD remained a significant predictor of long-term outcome of patients with PAD during follow-up for up to 4 years (until December 31, 2012; median, 775 days; 25th-75th percentiles, 469-1120 days); the hazard ratio was 2.59 (95% confidence interval, 2.21 to 2.78; P<0.001). The projected mortality rates after 4 years were 27% in patients without known CKD and 46%, 52%, 72%, and 78% in those with CKD stages 2, 3, 4, and 5, respectively. Lengths of hospital stay and reimbursement costs were on average nearly 1.4-fold higher (P<0.001) in patients who also had CKD.
This analysis illustrates the significant and important association of CKD with in-hospital and long-term mortality, morbidity, amputation rates, duration and costs of hospitalization, in-hospital treatment, and complications in patients with PAD.]]></description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.05600515</identifier><identifier>PMID: 26668023</identifier><language>eng</language><publisher>United States: American Society of Nephrology</publisher><subject>Aged ; Aged, 80 and over ; Amputation ; Chi-Square Distribution ; Comorbidity ; Cost-Benefit Analysis ; Critical Illness ; Female ; Hospital Costs ; Hospital Mortality ; Hospitalization - economics ; Humans ; Insurance, Health, Reimbursement ; Ischemia - diagnosis ; Ischemia - economics ; Ischemia - mortality ; Ischemia - therapy ; Length of Stay ; Male ; Middle Aged ; Multivariate Analysis ; Original ; Peripheral Arterial Disease - diagnosis ; Peripheral Arterial Disease - economics ; Peripheral Arterial Disease - mortality ; Peripheral Arterial Disease - therapy ; Proportional Hazards Models ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - economics ; Renal Insufficiency, Chronic - mortality ; Renal Insufficiency, Chronic - therapy ; Risk Factors ; Time Factors ; Treatment Outcome</subject><ispartof>Clinical journal of the American Society of Nephrology, 2016-02, Vol.11 (2), p.216-222</ispartof><rights>Copyright © 2016 by the American Society of Nephrology.</rights><rights>Copyright © 2016 by the American Society of Nephrology 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-26c1db56dc033d669a0455fe7ef764d32126728651fe49d4080db6cc41426aa43</citedby><cites>FETCH-LOGICAL-c384t-26c1db56dc033d669a0455fe7ef764d32126728651fe49d4080db6cc41426aa43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4741036/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4741036/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,729,782,786,887,27931,27932,53798,53800</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26668023$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lüders, Florian</creatorcontrib><creatorcontrib>Bunzemeier, Holger</creatorcontrib><creatorcontrib>Engelbertz, Christiane</creatorcontrib><creatorcontrib>Malyar, Nasser M</creatorcontrib><creatorcontrib>Meyborg, Matthias</creatorcontrib><creatorcontrib>Roeder, Norbert</creatorcontrib><creatorcontrib>Berger, Klaus</creatorcontrib><creatorcontrib>Reinecke, Holger</creatorcontrib><title>CKD and Acute and Long-Term Outcome of Patients with Peripheral Artery Disease and Critical Limb Ischemia</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>Clin J Am Soc Nephrol</addtitle><description><![CDATA[Despite the many studies showing an association between CKD and a high risk of ischemic events and mortality, the association of CKD with peripheral arterial disease (PAD) still has not been well described.
This large cohort study assessed the association of CKD, even in the earlier stages, with morbidity, short- and long-term outcome, and costs among patients with PAD.
We identified 41,882 patients with PAD who had an index hospitalization between January 1, 2009, and December 31, 2011. Of these, 8470 (20.2%) also had CKD (CKD stage 2: n=2158 [26%]; stage 3: n=3941 [47%]; stage 4: n=935 [11%]; stage 5: n=1436 [17%]). The ratio of women to men was 1:1.2. Compared with patients without known CKD, those with CKD had higher frequencies of coronary artery disease (1.8-fold higher; P<0.001), chronic heart failure (3.3-fold higher; P<0.001), and Rutherford PAD categories 5 and 6 (1.8-fold higher; P<0.001); underwent significantly fewer revascularizations (0.9-fold fewer; P<0.001); had a nearly two-fold higher amputation rate (P<0.001); had higher frequencies of in-hospital infections (2.1-fold higher; P<0.001), acute renal failure (2.8-fold higher; P<0.001), and sepsis (1.9-fold higher; P<0.001); had a 2.5-fold higher frequency of myocardial infarction (P<0.001); and had a nearly three-fold higher in-hospital mortality rate (P<0.001). In an adjusted multivariable Cox regression model, CKD remained a significant predictor of long-term outcome of patients with PAD during follow-up for up to 4 years (until December 31, 2012; median, 775 days; 25th-75th percentiles, 469-1120 days); the hazard ratio was 2.59 (95% confidence interval, 2.21 to 2.78; P<0.001). The projected mortality rates after 4 years were 27% in patients without known CKD and 46%, 52%, 72%, and 78% in those with CKD stages 2, 3, 4, and 5, respectively. Lengths of hospital stay and reimbursement costs were on average nearly 1.4-fold higher (P<0.001) in patients who also had CKD.
This analysis illustrates the significant and important association of CKD with in-hospital and long-term mortality, morbidity, amputation rates, duration and costs of hospitalization, in-hospital treatment, and complications in patients with PAD.]]></description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amputation</subject><subject>Chi-Square Distribution</subject><subject>Comorbidity</subject><subject>Cost-Benefit Analysis</subject><subject>Critical Illness</subject><subject>Female</subject><subject>Hospital Costs</subject><subject>Hospital Mortality</subject><subject>Hospitalization - economics</subject><subject>Humans</subject><subject>Insurance, Health, Reimbursement</subject><subject>Ischemia - diagnosis</subject><subject>Ischemia - economics</subject><subject>Ischemia - mortality</subject><subject>Ischemia - therapy</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Original</subject><subject>Peripheral Arterial Disease - diagnosis</subject><subject>Peripheral Arterial Disease - economics</subject><subject>Peripheral Arterial Disease - mortality</subject><subject>Peripheral Arterial Disease - therapy</subject><subject>Proportional Hazards Models</subject><subject>Renal Insufficiency, Chronic - diagnosis</subject><subject>Renal Insufficiency, Chronic - economics</subject><subject>Renal Insufficiency, Chronic - mortality</subject><subject>Renal Insufficiency, Chronic - therapy</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkc1Lw0AUxBdRrFZvnmWPHozud9KLUOK3RXuo4G3Zbl7alSapuxul_73RatHTG5gf8wYGoSNKzhij8jy_fzwjUhEiqdxCe1RKmQyIfNneaEF7aD-EV0KE4Ezuoh5TSmWE8T3k8odLbOoCD20b4VuNmnqWTMBX-KmNtqkANyUem-igjgF_uDjHY_BuOQdvFnjoI_gVvnQBTFgH5N5FZztv5Kopvgt2DpUzB2inNIsAhz-3j56vryb5bTJ6urnLh6PE8kzEhClLi6lUhSWcF0oNDBFSlpBCmSpRcEaZSlmmJC1BDApBMlJMlbWCCqaMEbyPLta5y3ZaQWG71l1PvfSuMn6lG-P0f6d2cz1r3rVIBSVcdQEnPwG-eWshRF25YGGxMDU0bdA0VZlUlA7SDj1do9Y3IXgoN28o0V_r6G4d_btOhx__rbaBf-fgnxVwijU</recordid><startdate>20160205</startdate><enddate>20160205</enddate><creator>Lüders, Florian</creator><creator>Bunzemeier, Holger</creator><creator>Engelbertz, Christiane</creator><creator>Malyar, Nasser M</creator><creator>Meyborg, Matthias</creator><creator>Roeder, Norbert</creator><creator>Berger, Klaus</creator><creator>Reinecke, Holger</creator><general>American Society of Nephrology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160205</creationdate><title>CKD and Acute and Long-Term Outcome of Patients with Peripheral Artery Disease and Critical Limb Ischemia</title><author>Lüders, Florian ; Bunzemeier, Holger ; Engelbertz, Christiane ; Malyar, Nasser M ; Meyborg, Matthias ; Roeder, Norbert ; Berger, Klaus ; Reinecke, Holger</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-26c1db56dc033d669a0455fe7ef764d32126728651fe49d4080db6cc41426aa43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amputation</topic><topic>Chi-Square Distribution</topic><topic>Comorbidity</topic><topic>Cost-Benefit Analysis</topic><topic>Critical Illness</topic><topic>Female</topic><topic>Hospital Costs</topic><topic>Hospital Mortality</topic><topic>Hospitalization - economics</topic><topic>Humans</topic><topic>Insurance, Health, Reimbursement</topic><topic>Ischemia - diagnosis</topic><topic>Ischemia - economics</topic><topic>Ischemia - mortality</topic><topic>Ischemia - therapy</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Original</topic><topic>Peripheral Arterial Disease - diagnosis</topic><topic>Peripheral Arterial Disease - economics</topic><topic>Peripheral Arterial Disease - mortality</topic><topic>Peripheral Arterial Disease - therapy</topic><topic>Proportional Hazards Models</topic><topic>Renal Insufficiency, Chronic - diagnosis</topic><topic>Renal Insufficiency, Chronic - economics</topic><topic>Renal Insufficiency, Chronic - mortality</topic><topic>Renal Insufficiency, Chronic - therapy</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lüders, Florian</creatorcontrib><creatorcontrib>Bunzemeier, Holger</creatorcontrib><creatorcontrib>Engelbertz, Christiane</creatorcontrib><creatorcontrib>Malyar, Nasser M</creatorcontrib><creatorcontrib>Meyborg, Matthias</creatorcontrib><creatorcontrib>Roeder, Norbert</creatorcontrib><creatorcontrib>Berger, Klaus</creatorcontrib><creatorcontrib>Reinecke, Holger</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lüders, Florian</au><au>Bunzemeier, Holger</au><au>Engelbertz, Christiane</au><au>Malyar, Nasser M</au><au>Meyborg, Matthias</au><au>Roeder, Norbert</au><au>Berger, Klaus</au><au>Reinecke, Holger</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>CKD and Acute and Long-Term Outcome of Patients with Peripheral Artery Disease and Critical Limb Ischemia</atitle><jtitle>Clinical journal of the American Society of Nephrology</jtitle><addtitle>Clin J Am Soc Nephrol</addtitle><date>2016-02-05</date><risdate>2016</risdate><volume>11</volume><issue>2</issue><spage>216</spage><epage>222</epage><pages>216-222</pages><issn>1555-9041</issn><eissn>1555-905X</eissn><abstract><![CDATA[Despite the many studies showing an association between CKD and a high risk of ischemic events and mortality, the association of CKD with peripheral arterial disease (PAD) still has not been well described.
This large cohort study assessed the association of CKD, even in the earlier stages, with morbidity, short- and long-term outcome, and costs among patients with PAD.
We identified 41,882 patients with PAD who had an index hospitalization between January 1, 2009, and December 31, 2011. Of these, 8470 (20.2%) also had CKD (CKD stage 2: n=2158 [26%]; stage 3: n=3941 [47%]; stage 4: n=935 [11%]; stage 5: n=1436 [17%]). The ratio of women to men was 1:1.2. Compared with patients without known CKD, those with CKD had higher frequencies of coronary artery disease (1.8-fold higher; P<0.001), chronic heart failure (3.3-fold higher; P<0.001), and Rutherford PAD categories 5 and 6 (1.8-fold higher; P<0.001); underwent significantly fewer revascularizations (0.9-fold fewer; P<0.001); had a nearly two-fold higher amputation rate (P<0.001); had higher frequencies of in-hospital infections (2.1-fold higher; P<0.001), acute renal failure (2.8-fold higher; P<0.001), and sepsis (1.9-fold higher; P<0.001); had a 2.5-fold higher frequency of myocardial infarction (P<0.001); and had a nearly three-fold higher in-hospital mortality rate (P<0.001). In an adjusted multivariable Cox regression model, CKD remained a significant predictor of long-term outcome of patients with PAD during follow-up for up to 4 years (until December 31, 2012; median, 775 days; 25th-75th percentiles, 469-1120 days); the hazard ratio was 2.59 (95% confidence interval, 2.21 to 2.78; P<0.001). The projected mortality rates after 4 years were 27% in patients without known CKD and 46%, 52%, 72%, and 78% in those with CKD stages 2, 3, 4, and 5, respectively. Lengths of hospital stay and reimbursement costs were on average nearly 1.4-fold higher (P<0.001) in patients who also had CKD.
This analysis illustrates the significant and important association of CKD with in-hospital and long-term mortality, morbidity, amputation rates, duration and costs of hospitalization, in-hospital treatment, and complications in patients with PAD.]]></abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>26668023</pmid><doi>10.2215/CJN.05600515</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Amputation Chi-Square Distribution Comorbidity Cost-Benefit Analysis Critical Illness Female Hospital Costs Hospital Mortality Hospitalization - economics Humans Insurance, Health, Reimbursement Ischemia - diagnosis Ischemia - economics Ischemia - mortality Ischemia - therapy Length of Stay Male Middle Aged Multivariate Analysis Original Peripheral Arterial Disease - diagnosis Peripheral Arterial Disease - economics Peripheral Arterial Disease - mortality Peripheral Arterial Disease - therapy Proportional Hazards Models Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - economics Renal Insufficiency, Chronic - mortality Renal Insufficiency, Chronic - therapy Risk Factors Time Factors Treatment Outcome |
| title | CKD and Acute and Long-Term Outcome of Patients with Peripheral Artery Disease and Critical Limb Ischemia |
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