Renal insufficiency and use of revascularization among a national cohort of men with advanced lower extremity peripheral arterial disease.

Ann M. O'Hare, Daniel Bertenthal, Anton N. Sidawy, Michael G. Shlipak, Saunak Sen, Mary Margaret Chren

Research output: Contribution to journalArticle

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Abstract

Although peripheral arterial disease is prevalent in patients with renal insufficiency, little is known about how the disease is managed in this patient group. The management of advanced limb ischemia was examined in a large cohort of male veterans (n = 6227). Patients were classified according to whether they underwent lower extremity revascularization, amputation, or no procedure within the first 6 mo after their first diagnosis of critical limb ischemia, defined as ischemic rest pain, ulceration, or gangrene. The association of renal insufficiency with revascularization and the association of management strategy with mortality within 1 yr of cohort entry were measured. Within 6 mo of initial diagnosis of critical limb ischemia, 39% of patients underwent lower extremity revascularization, 27% underwent major amputation, and 34% did not undergo either procedure. Patients with an estimated GFR 30 to 59 (adjusted odds ratio [OR] 0.84; 95% confidence interval [CI] 0.72 to 0.96), 15 to 29 ml/min per 1.73 m2 (OR 0.47; 95% CI 0.35 to 0.65), 15 ml/min per 1.73 m2 not on dialysis (OR 0.32; 95% CI 0.16 to 0.62), and dialysis patients (OR 0.62; 95% CI 0.47 to 0.84) were less likely to undergo revascularization than those with an estimated GFR > or = 60 ml/min per 1.73 m2. At all levels of renal function, mortality risk was lowest for patients who underwent revascularization. Patients with critical limb ischemia and concomitant renal insufficiency are less likely to be treated with revascularization. However, among patients with renal insufficiency, mortality is lowest for patients who receive a revascularization. Further studies are needed to determine the optimal care for this high-risk patient group.

Original languageEnglish (US)
Pages (from-to)297-304
Number of pages8
JournalClinical journal of the American Society of Nephrology : CJASN
Volume1
Issue number2
DOIs
StatePublished - Jan 1 2006

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Peripheral Arterial Disease
Renal Insufficiency
Lower Extremity
Ischemia
Extremities
Odds Ratio
Confidence Intervals
Amputation
Mortality
Dialysis
Gangrene
Veterans
Kidney
Pain

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Renal insufficiency and use of revascularization among a national cohort of men with advanced lower extremity peripheral arterial disease. / O'Hare, Ann M.; Bertenthal, Daniel; Sidawy, Anton N.; Shlipak, Michael G.; Sen, Saunak; Chren, Mary Margaret.

In: Clinical journal of the American Society of Nephrology : CJASN, Vol. 1, No. 2, 01.01.2006, p. 297-304.

Research output: Contribution to journalArticle

O'Hare, Ann M. ; Bertenthal, Daniel ; Sidawy, Anton N. ; Shlipak, Michael G. ; Sen, Saunak ; Chren, Mary Margaret. / Renal insufficiency and use of revascularization among a national cohort of men with advanced lower extremity peripheral arterial disease. In: Clinical journal of the American Society of Nephrology : CJASN. 2006 ; Vol. 1, No. 2. pp. 297-304.
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