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

ObjectivesThis study aimed to examine prognosis and causes of death in hemodialysis (HD) patients with critical limb ischemia (CLI) after endovascular therapy (EVT). BackgroundEVT 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. MethodsWe examined 175 consecutive patients who underwent EVT for CLI between March 2009 and March 2014. ResultsAmong 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. ConclusionsThe 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.