Risks and outcomes of critical limb ischemia in hemodialysis patients: a prospective cohort study.
Journal
Clinical kidney journal
Journal Volume
16
Journal Issue
3
Pages
585–595
ISSN
2048-8505
Date Issued
2023-03
Author(s)
Chuang, Shao-Yuan
Luo, Chien-Ming
Cheng, Chi-Hung
Lin, Po-Lin
Yang, Ten-Fang
Abstract
Peripheral arterial disease (PAD) is more common in patients receiving maintenance hemodialysis than in the general population. Critical limb ischemia (CLI), the most severe form of PAD, is associated with high amputation and mortality risk. However, few prospective studies are available evaluating this disease's presentation, risk factors and outcomes for patients receiving hemodialysis.
The Hsinchu VA study, a prospective multicentre study, investigated the impact of clinical factors on cardiovascular outcomes of patients receiving maintenance hemodialysis from January 2008 until December 2021. We evaluated the presentations and outcomes of patients with newly diagnosed PAD and the correlations of clinical variables with newly diagnosed CLI.
Of 1136 study participants, 1038 had no PAD on enrolment. After a median follow-up period of 3.3 years, 128 had newly diagnosed PAD. Of these, 65 presented with CLI, and 25 underwent amputation or died from PAD. Patients presenting with CLI had more below-the-knee (52%) and multi-level (41%) disease, and completely occluded segments (41%), and higher risk for amputation or PAD-related death compared with patients without CLI (27.7% vs 9.5%, = .01). After multivariate adjustment, disability, diabetes mellitus, current smoking and atrial fibrillation were significantly associated with newly diagnosed CLI.
Patients undergoing hemodialysis had higher rates of newly diagnosed CLI than the general population. Those with disabilities, diabetes mellitus, smoking and atrial fibrillation may require careful examination for PAD. Hsinchu VA study, ClinicalTrials.gov identifier: NCT04692636.
Subjects
critical limb ischemia
disability
hemodialysis
peripheral artery disease
SDGs
Type
journal article