Impact of Dialysis Vintage and Renal Biomarkers on Mortality in Dialysis-Dependent Patients With Critical Limb Ischemia Undergoing Revascularization

2021 ◽  
pp. 152660282110250
Author(s):  
Norihiro Kobayashi ◽  
Mitsuyoshi Takahara ◽  
Osamu Iida ◽  
Yoshimitsu Soga ◽  
Akio Kodama ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Serum Creatinine ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Surgical Reconstruction ◽  
Serum Urea ◽  
Risk Of Mortality ◽  
Dialysis Vintage ◽  
Phosphate Product ◽  
The Impact

Purpose: Revascularization of both endovascular therapy (EVT) and surgical reconstruction improve clinical outcomes of patients with critical limb ischemia (CLI); however, treatment of dialysis-dependent patients with CLI is still challenging. This study aimed to investigate the impact of dialysis-related parameters on the risk of mortality in dialysis-dependent patients undergoing revascularization for CLI. Materials and Methods: We retrospectively identified 274 dialysis-dependent patients with CLI (196 males; mean age 71 years), who underwent revascularization, from the clinical database of the surgical reconstruction vs peripheral intervention in patients with critical limb ischemia (SPINACH) study, which was a prospective, multicenter, observational study. Of these patients, 175 patients underwent EVT and 99 patients received surgical reconstruction. The current study evaluated the impact of dialysis vintage and renal biomarkers on the mortality rate of dialysis-dependent patients with CLI undergoing revascularization. Results: During a mean follow-up period of 1.7 ± 1.1 years, 147 deaths were observed. The 3-year overall survival rate and its standard error were estimated to be 40.5% ± 8.1% using the Kaplan-Meier method. A Cox proportional hazard analysis revealed that dialysis vintage ≥4 years, serum creatinine levels <4.7 mg/dL, serum urea nitrogen ≥88 mg/dL, and calcium-phosphate product ≥62.6 mg2/dL2 were independent risk factors for mortality after adjustment for the detailed mortality risk score developed in the SPINACH study. Adding these parameters to the original mortality risk score slightly, but not significantly, increased the area under the time-dependent receiver operating characteristics curve from 0.74 (95% CI, 0.67 to 0.81) to 0.77 (0.71 to 0.84) (p=0.084), whereas continuous net reclassification improvement reached 0.75 (0.12 to 0.90) (p=0.027). Conclusion: We found that long dialysis vintage, low serum creatinine, high serum urea nitrogen, and high calcium-phosphate product were independently associated with the increased risk of mortality in dialysis-dependent patients with CLI undergoing revascularization.

scholarly journals Cardiovascular and renal outcomes following percutaneous coronary intervention in a population with renal disease: a case-control study

QJM ◽  
2019 ◽  
Vol 112 (9) ◽  
pp. 669-674
Author(s):  
L A Allen ◽  
R D Pyart ◽  
J Holmes ◽  
K L Donovan ◽  
R A Anderson ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Calcium Phosphate ◽  
Serum Creatinine ◽  
Case Control Study ◽  
Coronary Intervention ◽  
Case Control ◽  
Percutaneous Coronary ◽  
Phosphate Product ◽  
Poor Outcomes ◽  
Control Study

Abstract Background Patients with renal disease are less likely to undergo percutaneous coronary intervention (PCI) due to concerns about poor outcomes. Aim We describe outcomes following PCI in individuals with chronic kidney disease (CKD), as compared with matched controls with comparable CKD who did not undergo PCI. We also identified factors predictive of poor outcomes following PCI amongst patients with CKD. Design Retrospective observational case-control study. Methods Cases were individuals with CKD (stages 1–5) undergoing PCI between 2008 and 2014. Controls were age, gender and creatinine-matched individuals not requiring PCI. We compared mortality between groups using Kaplan–Meier curves and Cox regression modelling. We assessed changes in serum creatinine using Wilcoxon Rank testing. We explored the relationship between biochemical and haematological measures (baseline creatinine, calcium, phosphate, calcium-phosphate product, parathyroid hormone, white cell count, haemoglobin, platelet count, c-reactive protein and total cholesterol) and post-PCI mortality, using logistic regression. Results We identified 144 cases and 144 controls. Mortality was significantly lower amongst cases compared with controls [hazard ratio 0.46 (95% confidence intervals 0.31, 0.69)]. PCI did not result in a significant change in renal function (P=0.52). Amongst cases, serum creatinine and calcium-phosphate product were predictors of mortality following PCI. Conclusion Cases undergoing PCI had lower mortality, and PCI was not associated with accelerated CKD progression. On this data, PCI should not be deferred as a treatment option in patients with CKD. Serum creatinine and calcium-phosphate product predict mortality following PCI in this cohort, and may be useful in risk-stratifying patients with CKD being considered for PCI.

scholarly journals The impact of chronic kidney disease on lower extremity bypass outcomes in patients with critical limb ischemia

2019 ◽  
Vol 69 (2) ◽  
pp. 491-496 ◽  
Author(s):  
Vishnu Ambur ◽  
Peter Park ◽  
John P. Gaughan ◽  
Scott Golarz ◽  
Frank Schmieder ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
The Impact

scholarly journals Prognostic factors and impact of peritoneal dialysis-related early peritonitis on mortality in Sardjito General Hospital, Yogyakarta, Indonesia

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Metalia Puspitasari ◽  
Heru Prasanto ◽  
Iri Kuswadi
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Prognostic Factors ◽  
Serum Creatinine ◽  
Early Onset ◽  
Late Onset ◽  
Lower Serum ◽  
Kaplan Meier ◽  
Risk Of Mortality ◽  
The Impact

Background Peritonitis has been reported to be asso­ciated with high mortality. However, information on the impact of the first peritonitis episode on continu­ous ambulatory peritoneal dialysis (CAPD) patients is sparse. ObjectiveTo determine the association between peritoneal dialysis-related early peritonitis and mor­tality. To determine prognostic factors on mortality in peritonitis patients with peritoneal dialysis. Methods A retrospective observational cohort study was conducted over 5 years at a single PD unit in Sardjito Hospital. Inclusion criteria: First onset of peritonitis patients with peritoneal dialysis from 2013 -2017, age ≥ 18 years old. Exclusion criteria: Incomplete medical records. A total of 48 patients on CAPD with peritonitis was divided into the early onset of peritonitis (< 20 months) and late onset of peritonitis ( ≥ 20 months. Kaplan-Meier survival curve was used to display cumulative relative risk as a parameter of prognostic factors. Results A total of 48 patients (early onset of peritonitis, n = 31; late onset of peritonitis, n = 17) were analyzed in our study with a mean of age50.6 years consisted of males 64.6%. There was a significant difference in patients’ mortality between the early and late onset of peritoni­tis. The Kaplan-Meier analysis revealed that log-rank test, p<0.05 with a mean survival time of patients with early peritonitis and late peritonitis was 236 days (95% CI: 162-309 days) and 1702 days (95% CI: 1067-2338 days) consecutively. Compared to those who were nor­moweight, underweight or overweight patients had in­creased risk of mortality, (RR 1.14 and 1.15; p=0.003, respectively). There was a significant association be­tween diabetes mellitus and lower serum creatinine levels, and the risk of mortality (RR 1.43, p=0.03 and mean difference -6.01, p< 0.001, respectively). Conclusions Early peritonitis patients have a poor prognosis compared to the late peritonitis group. Pa­tients with shorter time to first peritonitis were prone to having a higher mortality rate. Diabetes mellitus, under­weight or overweight, and lower serum creatinine are prognostic factors of mortality in peritonitis patients.

Impact of Tibial Runoff on Outcomes of Endovascular Treatment for Femoropopliteal Atherosclerotic Lesions

2018 ◽  
Vol 52 (7) ◽  
pp. 498-504 ◽  
Author(s):  
Ui Jun Park ◽  
Hyoung Tae Kim ◽  
Young-Nam Roh
Keyword(s):  
Critical Limb Ischemia ◽  
Endovascular Procedures ◽  
Limb Ischemia ◽  
Tissue Loss ◽  
Free Survival ◽  
Below The Knee ◽  
Atherosclerotic Lesions ◽  
The Poor ◽  
A Minor ◽  
The Impact

Objectives: The aim of this study is to investigate the impact of tibial runoff on outcomes of femoropopliteal interventions for atherosclerotic lesions. Methods: A retrospective review of 243 endovascular procedures for femoropopliteal atherosclerotic lesions on 243 limbs of 197 patients was performed. Results: The distribution rates of good tibial runoff (runoff score <7) and poor tibial runoff (runoff score ≥7) were 37.0% and 63.0%, respectively. In the poor tibial runoff group, the patients were older ( P = .019), and the proportion of male was lower ( P = .014). There was a significantly higher proportion of rest pain or tissue loss ( P < .001), and the prevalence of stroke ( P = .031) and renal insufficiency ( P = .005) was significantly higher in the poor runoff group. After femoropopliteal intervention, the amputation-free survival ( P = .03) and freedom from ischemia ( P = .003) were significantly lower in the poor runoff group. The interventions targeting below-the-knee (BTK) lesions performed concomitantly for critical limb ischemia or tissue loss with poor tibial runoff did not show a significant advantage in terms of freedom from ischemia; however, minor trends of longer lasting freedom from ischemia were observed when BTK intervention was combined. Conclusion: The patients with poor runoff showed significantly lower amputation-free survival and freedom from ischemia. In poor tibial runoff limbs with critical limb ischemia or tissue loss, BTK intervention did not demonstrate additional significant beneficial outcomes; however, there was a minor trend of longer lasting freedom from ischemia after concomitant BTK intervention.

Abstract 019: Diabetic Endothelial Progenitor Cells in Combination with an RGDS Presenting Peptide Amphiphile Enhance Recovery from Critical Limb Ischemia in Diabetic Mice

2013 ◽  
Vol 113 (suppl_1) ◽  
Author(s):  
Erin E Vaughan ◽  
Eduard Sleep ◽  
Sol Misener ◽  
Aiko Ito Klinger ◽  
Veronica Ramirez ◽  
...  
Keyword(s):  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Laser Doppler ◽  
Diabetic Mice ◽  
Endothelial Progenitor ◽  
Peptide Amphiphile ◽  
Post Surgery ◽  
The Impact

Approximately two million people suffer from critical limb ischemia (CLI) with the prevalence of the disease expected to rise. Thus, there is a crucial need to develop new therapies to enhance angiogenesis and minimize the impact of the blocked vessel(s). Cell therapy using endothelial progenitor cells (EPCs) has shown some promise, however, the cells may not remain at the site of injury long enough to significantly impact the course of the disease. Further, the use of autologous cells may be problematic as the underlying disease, such as diabetes, which resulted in CLI also appears to negatively impact the function of EPCs. Thus, we propose to use a biomaterial in combination with the EPCs to enhance both the retention of cells at the site of injury and also enhance the function of the cells. A self-assembling peptide amphiphile (PA) was developed with an attached functional group consisting of the cell-attachment sequence of peptides identified in fibronectin: RGDS. We hypothesize that EPCs combined with RGDS PA will improve the angiogenic response in CLI. Indeed, in vitro we found that EPCs from diabetic mice (db/db) exhibited increased survival on an RGDS PA in comparison to a scrambled sequence (DGRS) PA as measured by calcein-AM and ethidium homodimer-1 staining. To test if this enhanced survival would improve critical limb ischemia in diabetic mice, uni-lateral ischemia was induced by ligation of the femoral artery. Three days post surgery ischemia was confirmed by laser Doppler and the following treatments were injected into the ischemic limb of the diabetic mice: (1) PBS (2) scrambled PA (3) RGDS (4) scrambled PA +100,000 diabetic EPCs (5) RGDS PA + 100,000 diabetic EPCs. At four weeks post-injection, blood flow (as measured by laser Doppler) was increased in the group receiving RGDS PA when compared to the other groups (n>6). Further, necrosis was decreased in the RGDS PA group and muscle regeneration, as measured by the number of central nuclei, was increased in the RGDS PA group. Taken together, these results suggest that RGDS PA in combination with db/db EPCs enhances recovery from CLI in diabetic mice.

scholarly journals The Impact of Maternal Fructose Exposure on Angiogenic Activity of Endothelial Progenitor Cells and Blood Flow Recovery After Critical Limb Ischemia in Rat Offspring

2019 ◽  
Vol 20 (10) ◽  
pp. 2429 ◽  
Author(s):  
Steve Leu ◽  
Kay L. H. Wu ◽  
Wei-Chia Lee ◽  
You-Lin Tain ◽  
Julie Y. H. Chan
Keyword(s):  
Blood Flow ◽  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Cellular Migration ◽  
Endothelial Progenitor ◽  
Western Blots ◽  
Angiogenic Activity ◽  
The Impact

Adult metabolic syndrome is considered to be elicited by the developmental programming which is regulated by the prenatal environment. The maternal excess intake of fructose, a wildly used food additive, is found to be associated with developmental programing-associated cardiovascular diseases. To investigate the effect of maternal fructose exposure (MFE) on endothelial function and repair, which participate in the initiation and progress of cardiovascular disease, we applied a rat model with maternal fructose excess intake during gestational and lactational stage and examined the number and function of endothelial progenitor cells (EPCs) in 3-month-old male offspring with induction of critical limb ischemia (CLI). Results showed that the circulating levels of c-Kit+/CD31+ and Sca-1+/KDR+ EPC were reduced by MFE. In vitro angiogenesis analysis indicated the angiogenic activity of bone marrow-derived EPC, including tube formation and cellular migration, was reduced by MFE. Western blots further indicated the phosphorylated levels of ERK1/2, p38-MAPK, and JNK in circulating peripheral blood mononuclear cells were up-regulated by MFE. Fourteen days after CLI, the reduced blood flow recovery, lowered capillary density, and increased fibrotic area in quadriceps were observed in offspring with MFE. Moreover, the aortic endothelium-mediated vasorelaxant response in offspring was impaired by MFE. In conclusion, maternal fructose intake during gestational and lactational stage modulates the number and angiogenic activity of EPCs and results in poor blood flow recovery after ischemic injury.

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