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Mortality risk factors observed after CLI revascularization in hemodialysis patients
Advanced age, low albumin level and low ejection fraction were associated with an increased risk for 2-year mortality after surgical and endovascular revascularization in patients with critical limb ischemia who were on hemodialysis.
“In the clinical setting of [critical limb ischemia] patients on [hemodialysis], the numerous comorbidities render it difficult to decide on treatment strategy,” Tatsuya Shiraki, MD, of the Kansai Rosai Hospital in Amagasaki, Japan, and colleagues wrote. “Identification of prognostic factors and estimation of life expectancy for these patients are, therefore, clinically relevant.”
This led Shiraki and fellow researchers to conduct a study enrolling 246 consecutive patients (mean age, 69 years; 69% men) with critical limb ischemia (CLI) who were on hemodialysis. Patients were treated with either surgical (n = 68) or endovascular (n = 178) revascularization for de novo infrainguinal lesions between 2007 and 2009.
Most patients had diabetes (69%) and tissue loss (79%), and nearly half (45%) were nonambulatory.
At 1 year, survival was 77%, and at 2 years it was 66%. Survival rates at 2 years did not differ between groups (endovascular, 69% vs. surgery, 58%; P = .182).
The following risk factors significantly predicted mortality at 2 years: age older than 75 years (HR = 1.82; 95% CI, 1.14-2.91); albumin less than 3 g/dL (HR = 2.31; 95% CI, 1.39-3.84); and ejection fraction less than 50% (HR = 1.73; 95% CI, 1.06-2.83).
Additionally, as the number of risk factors increased, so too did the rate of 2-year mortality.
“Risk stratification by these risk factors would be useful in informing decision making on revascularization strategy,” Shiraki and colleagues concluded. – by Brian Ellis
Disclosure: The researchers report no relevant financial disclosures.