BOSTON — What is the impact of the severity of chronic kidney disease (CKD) on mortality and major adverse limb events (MALE) after endovascular revascularization of the superficial femoral artery (SFA)?
A new study led by Boston University Medical Center and the VA Boston Healthcare System took a close look at the effects of CKD on outcomes in peripheral artery disease (PAD). Also participating in the research were the Medical University of South Carolina and the Ralph H. Johnson VAMC, both in Charleston, SC, Harvard University and Brigham and Women’s Hospital, all in Boston.
The study team, which published their results in Catheterization and Cardiovascular Interventions, sought to assess the relationship of increasing severity of CKD on the risk of mortality and MALE in patients after endovascular revascularization of the SFA.1
To do that, researchers followed a cohort of 202 patients (253 limbs) with SFA endovascular revascularization for claudication or chronic limb-threatening ischemia in two academic centers between 2003 and 2011.
They categorized patients into four Kidney Disease Improving Global Outcomes (KDIGO) categories of increasingly worse CKD based on estimated glomerular filtration rate (eGFR) and defined the primary outcome as all-cause death. Secondary outcomes included cardiovascular death, noncardiovascular death and MALE.
Their results indicated that, during a median follow-up of 9.3 years, a graded and increasing risk of all-cause, cardiovascular, and noncardiovascular mortality occurred with worse eGFR (all tests of trend p < 0.001).
The researchers explained, “The lowest eGFR category (< 45 mL/min/1.73 m²) was associated with the highest risk of all-cause mortality (HR = 5.0, 95% CI = 2.4, 10), cardiovascular mortality (HR = 5.8, 95% CI = 1.8, 18), and noncardiovascular mortality (HR = 4.5, 95% CI = 1.9, 11). There was no significant association between CKD severity and MALE or minor revascularization events.”
The study concluded that the risk of mortality risk after SFA endovascular revascularization incrementally increases with decreasing renal function. “However, impaired renal function is not related to the risk of adverse limb events and supports femoral revascularization in these patients,” the authors added.
- Evans P, Sobieszczyk P, Eisenhauer AC, Todoran TM, Kinlay S. Chronic Kidney Disease and Risk of Mortality and Major Adverse Limb Events After Femoral Artery Endovascular Revascularization for Peripheral Artery Disease: The Boston Femoral Artery Endovascular Revascularization Outcomes (Boston FAROUT) Study. Catheter Cardiovasc Interv. 2025 Feb 10. doi: 10.1002/ccd.31447. Epub ahead of print. PMID: 39925321.
