Peripheral vascular disease-related procedures in dialysis patients

Predictors and prognosis

Laura C. Plantinga, Nancy E. Fink, Josef Coresh, Stephen M. Sozio, Rulan S. Parekh, Michal L. Melamed, Neil R. Powe, Bernard G. Jaar

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background and objectives: Peripheral vascular disease (PVD) is prevalent among dialysis patients, and many dialysis patients undergo PVD-related procedures. We aimed to examine the risk factors for and prognosis after such procedures in the dialysis setting. Design, setting, participants, & measurements: In a national prospective cohort study of 1041 incident dialysis patients, we examined the factors that are associated with PVD procedures (lower extremity amputations and bypasses) after the start of dialysis. Adjusted risk for PVD procedures of various factors was estimated using multivariable Cox proportional hazards models. Incidence rates of subsequent cardiovascular events, infectious hospitalizations, PVD- and cardiovascular disease-related mortality, and all-cause mortality were compared for those with and without a PVD procedure. Results: Overall, 217 (21%) patients underwent a PVD procedure after the start of dialysis. For those without diabetes, only PVD history (relative hazard [RH] 2.9; 95% confidence interval [CI] 1.3 to 6.6) and increased fibrinogen (RH 1.2; 95% CI 1.0 to 1.5) predicted PVD procedures. For those with diabetes, increased serum phosphate (RH 1.2; 95% CI 1.1 to 1.4), along with decreased albumin, increased C-reactive protein and fibrinogen, and lower SBP, was associated with risk for PVD procedures. Of those who had a procedure compared with those who did not, 68 versus 30% experienced a subsequent cardiovascular event, 85 versus 66% an infectious hospitalization, 11 versus 2% a PVD-related death, and 81 versus 59% all-cause death (mean follow-up 3.0 yr). Conclusions: Prognosis after PVD procedures is poor, and providers should be aware that risk factors for PVD procedures may differ by diabetes status.

Original languageEnglish (US)
Pages (from-to)1637-1645
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume4
Issue number10
DOIs
StatePublished - 2009

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Peripheral Vascular Diseases
Dialysis
Confidence Intervals
Fibrinogen
Hospitalization
Mortality
Amputation
Proportional Hazards Models
C-Reactive Protein
Cause of Death
Albumins
Lower Extremity
Cohort Studies
Cardiovascular Diseases

ASJC Scopus subject areas

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

Cite this

Peripheral vascular disease-related procedures in dialysis patients : Predictors and prognosis. / Plantinga, Laura C.; Fink, Nancy E.; Coresh, Josef; Sozio, Stephen M.; Parekh, Rulan S.; Melamed, Michal L.; Powe, Neil R.; Jaar, Bernard G.

In: Clinical Journal of the American Society of Nephrology, Vol. 4, No. 10, 2009, p. 1637-1645.

Research output: Contribution to journalArticle

Plantinga, Laura C. ; Fink, Nancy E. ; Coresh, Josef ; Sozio, Stephen M. ; Parekh, Rulan S. ; Melamed, Michal L. ; Powe, Neil R. ; Jaar, Bernard G. / Peripheral vascular disease-related procedures in dialysis patients : Predictors and prognosis. In: Clinical Journal of the American Society of Nephrology. 2009 ; Vol. 4, No. 10. pp. 1637-1645.
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abstract = "Background and objectives: Peripheral vascular disease (PVD) is prevalent among dialysis patients, and many dialysis patients undergo PVD-related procedures. We aimed to examine the risk factors for and prognosis after such procedures in the dialysis setting. Design, setting, participants, & measurements: In a national prospective cohort study of 1041 incident dialysis patients, we examined the factors that are associated with PVD procedures (lower extremity amputations and bypasses) after the start of dialysis. Adjusted risk for PVD procedures of various factors was estimated using multivariable Cox proportional hazards models. Incidence rates of subsequent cardiovascular events, infectious hospitalizations, PVD- and cardiovascular disease-related mortality, and all-cause mortality were compared for those with and without a PVD procedure. Results: Overall, 217 (21{\%}) patients underwent a PVD procedure after the start of dialysis. For those without diabetes, only PVD history (relative hazard [RH] 2.9; 95{\%} confidence interval [CI] 1.3 to 6.6) and increased fibrinogen (RH 1.2; 95{\%} CI 1.0 to 1.5) predicted PVD procedures. For those with diabetes, increased serum phosphate (RH 1.2; 95{\%} CI 1.1 to 1.4), along with decreased albumin, increased C-reactive protein and fibrinogen, and lower SBP, was associated with risk for PVD procedures. Of those who had a procedure compared with those who did not, 68 versus 30{\%} experienced a subsequent cardiovascular event, 85 versus 66{\%} an infectious hospitalization, 11 versus 2{\%} a PVD-related death, and 81 versus 59{\%} all-cause death (mean follow-up 3.0 yr). Conclusions: Prognosis after PVD procedures is poor, and providers should be aware that risk factors for PVD procedures may differ by diabetes status.",
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T1 - Peripheral vascular disease-related procedures in dialysis patients

T2 - Predictors and prognosis

AU - Plantinga, Laura C.

AU - Fink, Nancy E.

AU - Coresh, Josef

AU - Sozio, Stephen M.

AU - Parekh, Rulan S.

AU - Melamed, Michal L.

AU - Powe, Neil R.

AU - Jaar, Bernard G.

PY - 2009

Y1 - 2009

N2 - Background and objectives: Peripheral vascular disease (PVD) is prevalent among dialysis patients, and many dialysis patients undergo PVD-related procedures. We aimed to examine the risk factors for and prognosis after such procedures in the dialysis setting. Design, setting, participants, & measurements: In a national prospective cohort study of 1041 incident dialysis patients, we examined the factors that are associated with PVD procedures (lower extremity amputations and bypasses) after the start of dialysis. Adjusted risk for PVD procedures of various factors was estimated using multivariable Cox proportional hazards models. Incidence rates of subsequent cardiovascular events, infectious hospitalizations, PVD- and cardiovascular disease-related mortality, and all-cause mortality were compared for those with and without a PVD procedure. Results: Overall, 217 (21%) patients underwent a PVD procedure after the start of dialysis. For those without diabetes, only PVD history (relative hazard [RH] 2.9; 95% confidence interval [CI] 1.3 to 6.6) and increased fibrinogen (RH 1.2; 95% CI 1.0 to 1.5) predicted PVD procedures. For those with diabetes, increased serum phosphate (RH 1.2; 95% CI 1.1 to 1.4), along with decreased albumin, increased C-reactive protein and fibrinogen, and lower SBP, was associated with risk for PVD procedures. Of those who had a procedure compared with those who did not, 68 versus 30% experienced a subsequent cardiovascular event, 85 versus 66% an infectious hospitalization, 11 versus 2% a PVD-related death, and 81 versus 59% all-cause death (mean follow-up 3.0 yr). Conclusions: Prognosis after PVD procedures is poor, and providers should be aware that risk factors for PVD procedures may differ by diabetes status.

AB - Background and objectives: Peripheral vascular disease (PVD) is prevalent among dialysis patients, and many dialysis patients undergo PVD-related procedures. We aimed to examine the risk factors for and prognosis after such procedures in the dialysis setting. Design, setting, participants, & measurements: In a national prospective cohort study of 1041 incident dialysis patients, we examined the factors that are associated with PVD procedures (lower extremity amputations and bypasses) after the start of dialysis. Adjusted risk for PVD procedures of various factors was estimated using multivariable Cox proportional hazards models. Incidence rates of subsequent cardiovascular events, infectious hospitalizations, PVD- and cardiovascular disease-related mortality, and all-cause mortality were compared for those with and without a PVD procedure. Results: Overall, 217 (21%) patients underwent a PVD procedure after the start of dialysis. For those without diabetes, only PVD history (relative hazard [RH] 2.9; 95% confidence interval [CI] 1.3 to 6.6) and increased fibrinogen (RH 1.2; 95% CI 1.0 to 1.5) predicted PVD procedures. For those with diabetes, increased serum phosphate (RH 1.2; 95% CI 1.1 to 1.4), along with decreased albumin, increased C-reactive protein and fibrinogen, and lower SBP, was associated with risk for PVD procedures. Of those who had a procedure compared with those who did not, 68 versus 30% experienced a subsequent cardiovascular event, 85 versus 66% an infectious hospitalization, 11 versus 2% a PVD-related death, and 81 versus 59% all-cause death (mean follow-up 3.0 yr). Conclusions: Prognosis after PVD procedures is poor, and providers should be aware that risk factors for PVD procedures may differ by diabetes status.

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