Additive prognostic impact of chronic kidney disease and heart failure in patients with lower extremity artery disease
K Usami, Y Saito, K Yamamoto, Y Ohno, N Oka, M Takahara, S Suzuki, R Uchiyama, M Suzuki, T Matsumoto, Y Iwata, H Kitahara, Y KobayashiAbstract
Background
Patients with lower extremity artery disease (LEAD) represent one of the highest-risk populations in the field of cardiovascular disease. Recently, the cardiorenal interaction has emerged as a key contributor to the progression of cardiovascular disease. However, the prognostic impact of chronic kidney disease (CKD) and heart failure (HF), particularly when both conditions coexist, remains unclear in patients with LEAD.
Purpose
To elucidate the additive impact of CKD and HF on clinical outcomes in patients with LEAD.
Methods
This multicenter registry included 828 patients with LEAD undergoing endovascular treatment for aortoiliac and/or femoropopliteal lesions between 2019 and 2022. Patients were divided into three groups according to the presence of CKD and HF: neither CKD nor HF, either CKD or HF, and both. The primary endpoint was major adverse cardiovascular and limb events (MACLE), a composite of cardiovascular death, myocardial infarction, ischemic stroke, heart failure hospitalization, acute limb ischemia, chronic limb-threatening ischemia, and major amputation.
Results
Of the 828 patients, 311 (37.6%) had neither CKD nor HF, 412 (49.8%) had either CKD or HF, and 105 (12.7%) had both. During the median follow-up of 583 days, MACLE occurred in 52 (16.7%) patients with neither CKD nor HF, 98 (23.8%) with either CKD or HF, and 40 (38.1%) patients with both (P<0.001) (Figure). In the multivariable analysis, the stepwise accumulation of CKD and HF was associated with a progressively increased risk of MACLE.
Conclusions
Among patients with LEAD undergoing endovascular treatment, CKD and HF were common, both of which were associated with worse outcomes, particularly when they coexist. Our results suggest the clinical relevance of cardiorenal interaction in this vulnerable patient population.MACLE-free survival probabilityFor image description, please refer to the figure legend and surrounding text.