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Renal dysfunction predicts long-term mortality in patients with lower extremity arterial disease.
J Intern Med. 2007 Dec; 262(6):668-77.JI

Abstract

BACKGROUND

Patients with renal insufficiency tend to suffer from advanced atherosclerosis and exhibit a reduced life expectancy.

OBJECTIVES AND DESIGN

This prospective study investigated the relation between renal dysfunction and long-term all-cause and cardiovascular mortality in a population of nonsurgical patients with lower extremity arterial disease (LEAD).

SUBJECTS AND METHODS

A total of 357 patients with symptomatic LEAD underwent baseline glomerular filtration rate (GFR) estimation by the 4-variable Modification Diet in Renal Diseases equation, and were then followed for 4.2 years (range: 1-17).

RESULTS

During follow-up, 131 patients died (8.6 deaths per 100 patient-years), 79 of whom (60%) from cardiovascular causes. All-cause death rates were 3.8, 6.6, and 15.5 per 100 patient-years, respectively, in the groups with normal GFR, mild reduction in GFR (60-89 mL min(-1) per 1.73 m2) and chronic kidney disease (CKD; <60 mL min(-1) per 1.73 m2; P < 0.001 by log-rank test). Compared to patients with normal renal function, the risk of all-cause and cardiovascular death was significantly higher in patients with CKD [hazard ratio, respectively, 2.23, 95% confidence interval (CI): 1.16-4.34, P = 0.017; 2.15, 95% CI: 1.05-4.43, P = 0.03]. The association of CKD with all-cause and cardiovascular mortality were independent of age, LEAD severity, cardiovascular risk factors and treatment with angiotensin-converting enzyme (ACE)-inhibitors, hypolipidaemic and antiplatelet drugs. The power of GFR in predicting all-cause death was higher than that of ankle-brachial pressure index (P = 0.029) and Framingham risk score (P < 0.0001).

CONCLUSION

Chronic kidney disease strongly predicts long-term mortality in patients with symptomatic LEAD irrespective of disease severity, cardiovascular risk factors and concomitant treatments.

Authors+Show Affiliations

Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. lpasqua@unipg.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17908164

Citation

Pasqualini, L, et al. "Renal Dysfunction Predicts Long-term Mortality in Patients With Lower Extremity Arterial Disease." Journal of Internal Medicine, vol. 262, no. 6, 2007, pp. 668-77.
Pasqualini L, Schillaci G, Pirro M, et al. Renal dysfunction predicts long-term mortality in patients with lower extremity arterial disease. J Intern Med. 2007;262(6):668-77.
Pasqualini, L., Schillaci, G., Pirro, M., Vaudo, G., Siepi, D., Innocente, S., Ciuffetti, G., & Mannarino, E. (2007). Renal dysfunction predicts long-term mortality in patients with lower extremity arterial disease. Journal of Internal Medicine, 262(6), 668-77.
Pasqualini L, et al. Renal Dysfunction Predicts Long-term Mortality in Patients With Lower Extremity Arterial Disease. J Intern Med. 2007;262(6):668-77. PubMed PMID: 17908164.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renal dysfunction predicts long-term mortality in patients with lower extremity arterial disease. AU - Pasqualini,L, AU - Schillaci,G, AU - Pirro,M, AU - Vaudo,G, AU - Siepi,D, AU - Innocente,S, AU - Ciuffetti,G, AU - Mannarino,E, Y1 - 2007/10/01/ PY - 2007/10/3/pubmed PY - 2007/12/14/medline PY - 2007/10/3/entrez SP - 668 EP - 77 JF - Journal of internal medicine JO - J Intern Med VL - 262 IS - 6 N2 - BACKGROUND: Patients with renal insufficiency tend to suffer from advanced atherosclerosis and exhibit a reduced life expectancy. OBJECTIVES AND DESIGN: This prospective study investigated the relation between renal dysfunction and long-term all-cause and cardiovascular mortality in a population of nonsurgical patients with lower extremity arterial disease (LEAD). SUBJECTS AND METHODS: A total of 357 patients with symptomatic LEAD underwent baseline glomerular filtration rate (GFR) estimation by the 4-variable Modification Diet in Renal Diseases equation, and were then followed for 4.2 years (range: 1-17). RESULTS: During follow-up, 131 patients died (8.6 deaths per 100 patient-years), 79 of whom (60%) from cardiovascular causes. All-cause death rates were 3.8, 6.6, and 15.5 per 100 patient-years, respectively, in the groups with normal GFR, mild reduction in GFR (60-89 mL min(-1) per 1.73 m2) and chronic kidney disease (CKD; <60 mL min(-1) per 1.73 m2; P < 0.001 by log-rank test). Compared to patients with normal renal function, the risk of all-cause and cardiovascular death was significantly higher in patients with CKD [hazard ratio, respectively, 2.23, 95% confidence interval (CI): 1.16-4.34, P = 0.017; 2.15, 95% CI: 1.05-4.43, P = 0.03]. The association of CKD with all-cause and cardiovascular mortality were independent of age, LEAD severity, cardiovascular risk factors and treatment with angiotensin-converting enzyme (ACE)-inhibitors, hypolipidaemic and antiplatelet drugs. The power of GFR in predicting all-cause death was higher than that of ankle-brachial pressure index (P = 0.029) and Framingham risk score (P < 0.0001). CONCLUSION: Chronic kidney disease strongly predicts long-term mortality in patients with symptomatic LEAD irrespective of disease severity, cardiovascular risk factors and concomitant treatments. SN - 1365-2796 UR - https://www.unboundmedicine.com/medline/citation/17908164/Renal_dysfunction_predicts_long_term_mortality_in_patients_with_lower_extremity_arterial_disease_ L2 - https://doi.org/10.1111/j.1365-2796.2007.01863.x DB - PRIME DP - Unbound Medicine ER -