In-hospital outcome of peripheral vascular intervention in dialysis-dependent end-stage renal disease patients

Background: The impact of end-stage renal disease (ESRD) on peripheral vascular intervention (PVI) outcome remains incompletely elucidated. Objectives: We sought to compare the outcome of PVI in dialysis patients with those with normal kidney function. Methods: Using weighted data from the National Inpatient Sample database between 2002 and 2014, we identified all peripheral artery disease (PAD) patients aged ≥18 years that underwent PVI. Multivariate logistic regression analysis was performed to examine in-hospital outcomes. Results: Of 1,186,192 patients who underwent PVI, 1,066,830 had normal kidney function (89.9%) and 119,362 had ESRD requiring dialysis (10.1%). Critical limb ischemia was more prevalent in dialysis patients (63.2 vs. 34.0%, p <.001). Compared with normal kidney function group, ESRD requiring dialysis was associated with higher in-hospital mortality (1.5 vs. 4.2%, adjusted OR: 2.13 [95% CI: 2.04–2.23]) and longer length of hospital stay (median 3 days, Interquartile range [IQR] (0–6) vs. 7 days, IQR (4–18); p <.001). Dialysis patients had higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke; 14.3 vs. 9.8%, p <.001) and net adverse cardiovascular events (composite of MACE, major bleeding, or vascular complications; 40.8 vs. 29.1%, p <.001). ESRD patients less frequently underwent open bypass (5.6 vs. 8.5%, p <.001) and more frequently had major amputation (10.3 vs. 3.0%, p <.001) compared with normal kidney function group. Conclusion: PAD patients on dialysis who underwent PVI have higher rates of mortality and adverse outcomes as compared to those with normal kidney function.