TITLE:
Percutaneous Angioplasty in Diabetic Patients with Critical Limb Ischemia and Chronic Kidney Disease
AUTHORS:
Laura Giurato, Roberto Gandini, Marco Meloni, Enrico Pampana, Valeria Ruotolo, Valentina Izzo, Sebastiano Fabiano, Costantino Del Giudice, Luigi Uccioli
KEYWORDS:
Diabetes; Peripheral Arterial Disease; Chronic Kidney Disease; Angioplasty
JOURNAL NAME:
Open Journal of Endocrine and Metabolic Diseases,
Vol.3 No.3,
July
12,
2013
ABSTRACT: Introduction: Diabetes and Chronic Kidney Disease (CKD) are two strong risk factors
for peripheral arterial disease (PAD) and Critical Limb Ischemia (CLI). Further
renal insufficiency increases the risk of non healing wounds and major
amputation. Primary amputation rates of 22% to 44% have been reported for
ischaemic foot lesion in End-Stage Renal Disease (ESRD) patients. In our study
we evaluated the outcomes after Percutaneus Transluminal Angioplasty (PTA) in
diabetic patient in relation to different CKD classes. Materials and Methods: We studied a group of 456 diabetic patients with PAD complicated by foot lesion
who underwent PTA because of a CLI. According to the estimated Glomerular
Filtration Rate (eGFR mL/min/1.73
m2) we divided the patients into five CKD groups:
group 1 eGFR > 90, group 2 eGFR 90 - 60 (n = 160), group 3 eGFR 60 - 30 (n =
152), group 4 eGFR 30 -15 (n = 34) and group 5 Results: Alive without major amputation, alive with major amputation and death were
respectively: for group 1 (77.8%, 11.1%, 11.1%), for group 2 (74.4%, 12.5%,
13.1%), for group 3 (80.3%, 11.2%, 8.5%), for group 4 (82.3%, 8.8%, 8.8%). They
were 60%, 18.3%, 21.7% for group 5 significantly different from the other CKD
groups (χ2 = 0.0175). Our
analysis did not highlight any relationship between eGFR and outcomes and eGFR
did not show any significant difference according to the different outcomes,
and were respectively 60.2 ± 1.3, 61.8 ± 3.4, 63.8 ± 3.5 (P = ns). Conclusion: The outcomes were similar
for groups 1-4 and therefore, according to our data, they seemed not to be
influenced by the decline of GFR. Outcomes worse significantly in group 5, but
this group included only patients with ESRD in dialysis treatment. Although the
outcomes after PTA in group 5 was significantly worse than the other groups,
still a 60% limb salvage rate was obtained with PTA also in these very fragile
patients. PTA was much less aggressive than by-pass and PTA was the only method
used to treat CLI in our patients. This could explain why we recorded similar
outcomes in all groups despite the decline of GFR that, generally speaking,
mirrors a worsening of the general clinical conditions. Worse outcomes were
recorded only in group 5 and in this group dialysis by itself might be responsible
of the different outcomes.