Chronic kidney disease as a predictor of long-term adverse cardiovascular outcomes in patients with aortoiliac disease: a prospective cohort study

BACKGROUND: Aortoiliac disease poses a significant cardiovascular (CV) risk, especially in individuals with chronic kidney disease. This study aimed to assess the predictive role of chronic kidney disease in long-term major adverse CV events in patients submitted to aortoiliac revascularization due to severe aortoiliac atherosclerotic disease. METHODS: From 2013 to 2023, patients who underwent aortoiliac revascularization for TASC II type D lesions, including those with chronic kidney disease, were selected from a prospective cohort study. Demographic, clinical, and postoperative data were collected. Prognostic factors were evaluated for their independent impact on outcomes using survival analysis with a multivariate Cox regression model. RESULTS: The study included 135 patients, 93.3% male, with a mean age of 62.39 +/- 9.20 years. Chronic kidney disease was associated with higher prevalence of short-term myocardial injury after noncardiac surgery (54.5%, P=0.014) and was a long-term predictor of acute heart failure (Hazard Ratio=4.884; 95% confidence interval 2.377-22.802; P=0.007), major adverse CV events (HR 2.992; 95% CI 1.498-5.975, P=0.002) and all-cause mortality (HR 3.296; 95% CI 1.626-6.682, P<0.001). The multivariable analysis revealed significant associations between major adverse CV events and the following predictors: chronic kidney disease (adjusted HR=2.416, 95% CI 1.171-4.984, P=0.017) and congestive heart failure (adjusted HR=2.633, 95% CI 1.233-5.623, P=0.012). CONCLUSIONS: Chronic kidney disease is a recognized CV risk factor and an independent predictor of long-term acute heart failure, major adverse CV events, and all-cause mortality. These findings underscore the importance of early identification of CV complications and stricter long-term follow-up for chronic kidney disease patients undergoing aortoiliac revascularization.