Refinement of survival prediction in patients undergoing lower extremity bypass surgery: Stratification by chronic kidney disease classification
Refinement of survival prediction in patients undergoing lower extremity bypass surgery: Stratification by chronic kidney disease classification
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DOI：
10.1016/j.jvs.2007.01.025
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发表时间：
2007-05-01
影响因子：
4.3
通讯作者：
Conte, Michael S.
中科院分区：
文献类型：
--
作者：
Owens, Christopher D.;Ho, Karen J.;Conte, Michael S.
目的：终末期肾病（ESRD）给接受下肢血运重建术的个体带来显著的生存劣势；然而，轻度肾功能损害的影响尚不清楚。本研究探讨了慢性肾脏疾病（CKD）分类对下肢动脉重建患者的生存、肢体保留和移植物通畅的预后意义。方法：对1995年1月31日至2004年12月21日期间连续接受首次下肢静脉搭桥手术的患者进行前瞻性登记。肾小球滤过率（GFR）是用每位患者术前肌酐浓度来估算的。CKD的分类取自目前的国家肾脏基金会肾脏疾病结局质量倡议分期标准。结果：该队列包括456名受试者，平均（+/- SD）年龄为68.1 +/- 10.8岁。男性274例（60%），白种人378例（82.5%）。合并症包括糖尿病270例（59.0%），高血压333例（72.7%），冠状动脉疾病242例（52.8%），血脂异常203例（44.5%）。手术指征为危急肢体缺血384例（83.8%）。在检查的变量中，糖尿病和严重缺血作为旁路手术的指征明显倾向于较高的CKD分类(P
Objective: End-stage renal disease (ESRD) imparts a significant survival disadvantage to individuals undergoing lower extremity revascularization; however, the influence of lesser degrees of renal impairment remains unclear. This study examined the prognostic significance of the chronic kidney disease (CKD) classification on survival, limb salvage, and graft patency in patients undergoing lower extremity arterial reconstruction.Methods:A prospective registry was evaluated for consecutive patients between January 31, 1995, and December 21, 2004, undergoing first-time, lower extremity vein bypass surgery. Glomerular filtration rate (GFR) was estimated with the Modification of Diet in Renal Disease equation using each patient's preoperative creatinine concentration. CKD categories were taken from current National Kidney Foundation Kidney Disease Outcomes Quality Initiative staging criteria.Results: The cohort included 456 subjects, with a mean (+/- SD) age of 68.1 +/- 10.8 years. There were 274 men (60%) and 378 Caucasians (82.5%). Comorbidities included diabetes mellitus in 270 (59.0%), hypertension in 333 (72.7%), coronary artery disease in 242 (52.8%), and dyslipidemia in 203 (44.5%). The surgical indication was critical limb ischemia in 384 (83.8%). Among the variables examined, diabetes and critical ischemia as the indication for bypass were significantly skewed toward higher CKD classifications (P