Risk of Kidney Failure, Death, and Cardiovascular Events After Lower Limb Complications in Patients With CKD.
Risk of Kidney Failure, Death, and Cardiovascular Events After Lower Limb Complications in Patients With CKD.
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DOI：
10.1016/j.ekir.2020.11.010
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发表时间：
2021-03
影响因子：
6
通讯作者：
Tangri N
中科院分区：
文献类型：
--
作者：
Li K;Ferguson T;Embil J;Rigatto C;Komenda P;Tangri N
下肢并发症是外周动脉疾病（PAD）和慢性肾病（CKD）患者的主要不良事件。这些并发症可导致发病率、残疾、生活质量降低和更高的医疗费用。我们试图确定中期下肢并发症如何改变一组G3至G5期CKD患者随后进展为肾衰竭的风险、肾衰竭前的全因死亡率和心血管（CV）事件。我们进行了一项回顾性队列研究，使用患者水平的数据，这些数据是通过链接加拿大马尼托巴的几个管理数据库获得的。我们使用Fine和Gray回归模型分析主要结局：（1）调整全因死亡竞争风险的肾衰竭，（2）肾衰竭前死亡，（3）心血管相关住院与非CV死亡竞争风险。最终队列共纳入92，618例患者，中位随访时间为2.56年。与未发生暂时性下肢并发症的患者相比，（校正风险比[HR] 2.51，95%置信区间[CI] 2.10-3.00），肾衰竭前全因死亡率（调整后HR 2.73，95%CI 2.55-2.92）和CV事件（调整后HR 2.12，95%CI 1.90-2.38）。中期下肢并发症与肾衰竭、肾衰竭前全因死亡率和心血管相关住院的风险增加相关。对有下肢并发症风险的CKD患者进行筛查和治疗策略的临床试验可能有助于确定管理这种风险的最佳策略。
Lower limb complications are major adverse events in patients with peripheral artery disease (PAD) and chronic kidney disease (CKD). These complications can lead to morbidity, disability, reduced quality of life, and higher health care costs. We sought to determine how interim lower limb complications modify the subsequent risk of progression to kidney failure, all-cause mortality before kidney failure, and cardiovascular (CV) events in a cohort of patients with CKD stages G3 to G5. We performed a retrospective cohort study using patient-level data obtained by linking several administrative databases from Manitoba, Canada. We used Fine and Gray regression models for the primary outcomes of (1) kidney failure adjusted for the competing risk of all-cause mortality, (2) death before kidney failure, and (3) cardiovascular-related hospitalization with the competing risk of non-CV death. A total of 92,618 patients were included in the final cohort, with a median follow-up time of 2.56 years. Compared with patients who did not experience an interim lower limb complication, there was a higher risk of kidney failure (adjusted hazard ratio [HR] 2.51, 95% confidence interval [CI] 2.10–3.00), all-cause mortality before kidney failure (adjusted HR 2.73, 95% CI 2.55–2.92), and CV events (adjusted HR 2.12, 95% CI 1.90–2.38). Interim lower limb complications are associated with an increased risk of kidney failure, all-cause mortality before kidney failure, and cardiovascular-related hospitalization. Clinical trials of screening and treatment strategies for patients with CKD at risk for lower limb complications may help determine optimal strategies to manage this risk.
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