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Different association between renal dysfunction and clinical outcomes according to the presence of diabetes in patients undergoing endovascular treatment for peripheral artery disease

Authors
 Jihoon Kim  ;  Taek Kyu Park  ;  Ki Hong Choi  ;  Donghoon Choi  ;  Young-Guk Ko  ;  Jae-Hwan Lee  ;  Chang-Hwan Yoon  ;  In-Ho Chae  ;  Cheol Woong Yu  ;  Pil-Ki Min  ;  Seung-Whan Lee  ;  Sang-Rok Lee  ;  Yoon Seok Koh  ;  Seung-Hyuk Choi 
Citation
 JOURNAL OF VASCULAR SURGERY, Vol.71(1) : 132-140.e1, 2020-01 
Journal Title
JOURNAL OF VASCULAR SURGERY
ISSN
 0741-5214 
Issue Date
2020-01
MeSH
Aged ; Amputation ; Diabetes Mellitus / diagnosis ; Diabetes Mellitus / epidemiology* ; Endovascular Procedures* / adverse effects ; Female ; Glomerular Filtration Rate* ; Humans ; Kidney / physiopathology* ; Limb Salvage ; Male ; Middle Aged ; Peripheral Arterial Disease / diagnostic imaging ; Peripheral Arterial Disease / epidemiology ; Peripheral Arterial Disease / physiopathology ; Peripheral Arterial Disease / therapy* ; Registries ; Renal Insufficiency, Chronic / diagnosis ; Renal Insufficiency, Chronic / epidemiology* ; Renal Insufficiency, Chronic / physiopathology ; Republic of Korea / epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
Keywords
Peripheral artery disease ; Endovascular treatment ; Renal dysfunction ; Diabetes mellitus
Abstract
Objective: Although chronic kidney disease (CKD) and diabetes are important prognostic factors in patients with peripheral artery disease, there are limited data regarding the outcomes of endovascular treatment (EVT) according to the severity of CKD, especially in the presence of diabetes. This study sought to compare clinical outcomes of lower limb EVT between patients with and patients without CKD according to the presence of diabetes. Methods: Patients were enrolled from the Korean multicenter EVT registry and were divided according to the presence of diabetes, then further stratified by CKD (estimated glomerular filtration rate <60 mL/min/1.73 m(2)). The primary outcome was major adverse limb events (MALEs; a composite of reintervention for target limb, reintervention for target vessel, and unplanned major amputation) at 2 years. Results: A total of 3045 patients were eligible for analysis: 1277 nondiabetic patients (944 without CKD, 333 with CKD) and 1768 diabetic patients (951 without CKD, 817 with CKD). CKD was associated with a significantly increased risk of MALEs after EVT in diabetic patients (14.4% vs 9.9%; adjusted hazard ratio, 1.60; 95% confidence interval, 1.28-2.01; P < .001) but not in nondiabetic patients (7.6% vs 9.7%; adjusted hazard ratio, 0.78; 95% confidence interval, 0.53-1.14; P = .203; interaction P = .018). In analysis stratified by the severity of CKD among diabetic patients, end-stage renal disease was significantly associated with an increased risk of MALE. Conclusions: CKD was associated with a significantly higher risk of MALEs after EVT in diabetic patients but not in nondiabetic patients. The increased risk of MALEs was mainly driven by patients with end-stage renal disease.
Files in This Item:
T9992020519.pdf Download
DOI
10.1016/j.jvs.2019.03.071
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Min, Pil Ki(민필기) ORCID logo https://orcid.org/0000-0001-7033-7651
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/190294
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