Clinical outcome and its predictors in hemodialysis patients with critical limb ischemia undergoing endovascular therapy.

OBJECTIVES: This study aimed to examine prognosis and causes of death in hemodialysis (HD) patients with critical limb ischemia (CLI) after endovascular therapy (EVT).

BACKGROUND: EVT is becoming a first-line treatment in patients with CLI. Nonetheless, only a few studies have examined prognosis and its predictors in HD patients with CLI undergoing EVT, who are known to be at high-risk. Moreover, causes of death in this population are not clarified to date.

METHODS: We examined 175 consecutive patients who underwent EVT for CLI between March 2009 and March 2014.

RESULTS: Among these, 126 patients were dependent on HD and their 2-year all-cause death and 2-year major amputation rates were 28% and 14%, respectively. Cox proportional hazards analyses revealed that lower body mass index (hazard ratio [HR] = 0.89, 95% confidence interval [CI] = 0.82-0.98, P = 0.03) and prior stroke (HR = 2.34, 95%CI = 1.10-4.85, P = 0.03) were independent predictors of all-cause death, and lower serum albumin (HR = 0.44, 95%CI = 0.22-0.92, P = 0.03) along with currently smoking (HR = 4.73, 95%CI = 1.43-14.1, P = 0.01) were independent predictors of major amputation in HD patients. The leading cause of death in this population was infections, most of which were lower extremity infections.

CONCLUSIONS: The incidences of all-cause death and major amputation seemed acceptable in HD patients undergoing EVT for CLI. In this high-risk subset, management of infection might be a potential therapeutic target.