دورية أكاديمية
Impact of Chronic Kidney Disease on In-Hospital Outcomes of Hospitalizations With Acute Limb Ischemia Undergoing Endovascular Therapy.
| العنوان: | Impact of Chronic Kidney Disease on In-Hospital Outcomes of Hospitalizations With Acute Limb Ischemia Undergoing Endovascular Therapy. |
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| المؤلفون: | Patel HP; Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA., Decter D; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Thakkar S; Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA., Anantha-Narayanan M; Department of Interventional Cardiology, The University of Arizona and Banner University Medical Center, Phoenix, AZ, USA., Kumar A; Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA., Sheth AR; Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA., Zahid S; Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA., Patel BA; Department of Cardiology, Apex Heart Institute, Ahmedabad, India., Patel T; Department of Cardiovascular Diseases, AdventHealth Medical Group, Orlando, FL, USA., Devani H; Department of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Shah V; Department of Endocrinology, University of Massachusetts, Worcester, MA, USA., Doshi PM; Department of Medicine, Ramaiah Medical College, Bangalore, India., Patel S; Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, NY, USA., Shariff M; Department of Surgery, Mayo Clinic, Rochester, MN, USA., Adalja D; Department of Medicine, Gujarat Medical Education & Research Society Gotri Medical College, Vadodara, India., Vallabhajosyula S; Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA., Doshi R; Department of Internal Medicine, University of Nevada Reno School of Medicine, NV, USA. |
| المصدر: | Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2024 Aug; Vol. 31 (4), pp. 606-614. Date of Electronic Publication: 2022 Nov 18. |
| نوع المنشور: | Journal Article; Comparative Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Sage Publications Country of Publication: United States NLM ID: 100896915 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1545-1550 (Electronic) Linking ISSN: 15266028 NLM ISO Abbreviation: J Endovasc Ther Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2015- : Thousand Oaks, CA : Sage Publications Original Publication: Phoenix, AZ : The Society, c2000- |
| مواضيع طبية MeSH: | Endovascular Procedures*/adverse effects , Endovascular Procedures*/mortality , Ischemia*/mortality , Ischemia*/therapy , Ischemia*/surgery , Hospital Mortality* , Peripheral Arterial Disease*/mortality , Peripheral Arterial Disease*/therapy , Peripheral Arterial Disease*/complications , Databases, Factual* , Renal Insufficiency, Chronic*/complications , Renal Insufficiency, Chronic*/mortality , Renal Insufficiency, Chronic*/therapy , Renal Insufficiency, Chronic*/diagnosis, Humans ; Male ; Female ; Aged ; Risk Factors ; Treatment Outcome ; Middle Aged ; Time Factors ; Risk Assessment ; United States ; Acute Disease ; Retrospective Studies ; Aged, 80 and over ; Kidney Failure, Chronic/therapy ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/diagnosis ; Amputation, Surgical ; Limb Salvage ; Inpatients ; Hospitalization |
| مستخلص: | Purpose: Studies on outcomes related to endovascular treatment (EVT) in advanced stages of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among hospitalizations with acute limb ischemia (ALI) are limited. Methods: The Nationwide Inpatient Sample was quarried from October 2015 to December 2017 to identify the hospitalizations with ALI and undergoing EVT. The study population was subdivided into 3 groups based on their CKD stages: group 1 (No CKD, stage I, stage II), group 2 (CKD stage III, stage IV), and group 3 (CKD stage V and ESRD). The primary outcome was all-cause in-hospital mortality. Results: A total of 51 995 hospitalizations with ALI undergoing EVT were identified. The in-hospital mortality was significantly higher in group 2 (OR = 1.17; 95% CI 1.04 - 1.32, p =0.009) and group 3 (OR = 3.18; 95% CI 2.74-3.69, p <0.0001) compared with group 1. Odds of minor amputation, vascular complication, atherectomy, and blood transfusion were higher among groups 2 and 3 compared with group 1. Group 2 had higher odds of access site hemorrhage compared with groups 1 and 3, whereas group 3 had higher odds of major amputation, postprocedural infection, and postoperative hemorrhage compared with groups 1 and 2. Besides, groups 2 and 3 had lower odds of discharge to home compared with group 1. Finally, the length of hospital stay and cost of care was significantly higher with the advancing CKD stages. Conclusion: Advanced CKD stages and ESRD are associated with higher mortality, worse in-hospital outcomes and higher resource utilization among ALI hospitalizations undergoing EVT. Clinical Impact: Current guidelines are not clear for the optimum first line treatment of acute limb ischemia, especially in patients with advanced kidney disease as compared to normal/mild kidney disease patients. We found that advanced kidney disease is a significant risk factor for worse in-hospital morbidity and mortality. Furthermore, patients with acute limb ischemia and advanced kidney disease is associated with significantly higher resource utilization as compared to patients with normal/mild kidney disease. This study suggests shared decision making between treating physician and patients when considering endovascular therapy for the treatment of acute limb ischemia in patients with advanced kidney disease. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| فهرسة مساهمة: | Keywords: acute limb ischemia; chronic kidney disease; end-stage renal disease; endovascular treatment; peripheral arterial disease |
| تواريخ الأحداث: | Date Created: 20221119 Date Completed: 20240730 Latest Revision: 20240730 |
| رمز التحديث: | 20240730 |
| DOI: | 10.1177/15266028221134887 |
| PMID: | 36401519 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1545-1550 |
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| DOI: | 10.1177/15266028221134887 |