Polyvascular Atherosclerotic Disease in Chronic Kidney Disease Patients
Polyvascular Atherosclerotic Disease in Chronic Kidney Disease Patients
Background. Atherosclerotic disease is often extended to multiple affected vascular beds (AVB). Polyvascular disease (PVD) and chronic kidney disease (CKD) have both separately been associated with an adverse cardiovascular outcome. We assessed the prevalence of PVD in vascular surgery patients with preoperative CKD and studied the influence on long-term cardiovascular survival.
Methods. Consecutive patients (2933) were preoperatively screened for PVD, defined as 1-, 2- or 3-AVB. Preoperative glomerular filtration rate (GFR in ml/min/1.73 m body-surface area) was estimated by the Modification of Diet in Renal Disease (MDRD) prediction equation, and patients were categorized according their estimated GFR. Primary end point was (cardiovascular) mortality during a median follow-up of 6.0 years (IQR 2–9).
Results. Preoperative MDRD-GFR was classified as normal kidney function (GFR ≥ 90) or mild (GFR 60–89), moderate (GFR 30–59) and severe (GFR < 30) kidney disease in 779 (27%), 1423 (48%), 605 (21%) and 124 (4%) patients, respectively. One-vessel disease was present in 54% of the patients with normal kidney function, while 62% of the patients with CKD (GFR < 60) had PVD. In patients with moderate or severe kidney disease, the presence of PVD was independently associated with even higher cardiovascular mortality rates (2-AVB: HR 1.65 95%CI 1.09–2.48; 3-AVB: 2.07 95%CI 1.08–3.99), compared to 1-AVB.
Conclusion. Patients with CKD had a high prevalence of PVD, which was independently associated with increased all-cause and cardiovascular mortality.
With aging of the population, the prevalence of atherosclerotic disease and its associated adverse outcomes is increasing. It has to be noted that the process of established atherothrombosis is not limited to a single arterial location. The Reduction of Atherothrombosis for Continued Health (REACH) registry showed that one out of six patients with peripheral arterial disease (PAD), cerebrovascular disease (CVD) or coronary artery disease (CAD) had involvement of one or two other arterial beds. The presence of polyvascular disease has been demonstrated to be an independent predictor of long-term cardiovascular outcome in the general population.
Chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (GFR) of <60 ml/min/1.73 m, is a worldwide public health problem with poor outcomes and high costs, and kidney failure requiring treatment with chronic dialysis or kidney transplantation is the most visible outcome of this patient population. However, patients with CKD also frequently have associated cardiovascular disease, as individuals with CKD are more likely to die of a cardiovascular event than to develop kidney failure.
The studies mentioned above have shown a worse prognosis of patients in the general population with polyvascular disease, and other studies have demonstrated a graded relationship between a reduced estimated GFR and the risk of death and cardiovascular events. However, no prior studies have examined the influence of preoperative reduced estimated GFR and polyvascular disease on long-term outcome in PAD patients undergoing elective vascular surgery. Therefore, the aim of the current study was to assess (i) the prevalence of polyvascular disease in PAD patients with preoperative CKD and (ii) the influence of polyvascular disease in CKD patients on long-term outcome.
Abstract and Introduction
Abstract
Background. Atherosclerotic disease is often extended to multiple affected vascular beds (AVB). Polyvascular disease (PVD) and chronic kidney disease (CKD) have both separately been associated with an adverse cardiovascular outcome. We assessed the prevalence of PVD in vascular surgery patients with preoperative CKD and studied the influence on long-term cardiovascular survival.
Methods. Consecutive patients (2933) were preoperatively screened for PVD, defined as 1-, 2- or 3-AVB. Preoperative glomerular filtration rate (GFR in ml/min/1.73 m body-surface area) was estimated by the Modification of Diet in Renal Disease (MDRD) prediction equation, and patients were categorized according their estimated GFR. Primary end point was (cardiovascular) mortality during a median follow-up of 6.0 years (IQR 2–9).
Results. Preoperative MDRD-GFR was classified as normal kidney function (GFR ≥ 90) or mild (GFR 60–89), moderate (GFR 30–59) and severe (GFR < 30) kidney disease in 779 (27%), 1423 (48%), 605 (21%) and 124 (4%) patients, respectively. One-vessel disease was present in 54% of the patients with normal kidney function, while 62% of the patients with CKD (GFR < 60) had PVD. In patients with moderate or severe kidney disease, the presence of PVD was independently associated with even higher cardiovascular mortality rates (2-AVB: HR 1.65 95%CI 1.09–2.48; 3-AVB: 2.07 95%CI 1.08–3.99), compared to 1-AVB.
Conclusion. Patients with CKD had a high prevalence of PVD, which was independently associated with increased all-cause and cardiovascular mortality.
Introduction
With aging of the population, the prevalence of atherosclerotic disease and its associated adverse outcomes is increasing. It has to be noted that the process of established atherothrombosis is not limited to a single arterial location. The Reduction of Atherothrombosis for Continued Health (REACH) registry showed that one out of six patients with peripheral arterial disease (PAD), cerebrovascular disease (CVD) or coronary artery disease (CAD) had involvement of one or two other arterial beds. The presence of polyvascular disease has been demonstrated to be an independent predictor of long-term cardiovascular outcome in the general population.
Chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (GFR) of <60 ml/min/1.73 m, is a worldwide public health problem with poor outcomes and high costs, and kidney failure requiring treatment with chronic dialysis or kidney transplantation is the most visible outcome of this patient population. However, patients with CKD also frequently have associated cardiovascular disease, as individuals with CKD are more likely to die of a cardiovascular event than to develop kidney failure.
The studies mentioned above have shown a worse prognosis of patients in the general population with polyvascular disease, and other studies have demonstrated a graded relationship between a reduced estimated GFR and the risk of death and cardiovascular events. However, no prior studies have examined the influence of preoperative reduced estimated GFR and polyvascular disease on long-term outcome in PAD patients undergoing elective vascular surgery. Therefore, the aim of the current study was to assess (i) the prevalence of polyvascular disease in PAD patients with preoperative CKD and (ii) the influence of polyvascular disease in CKD patients on long-term outcome.
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