Key result
Stage 5 CKD linked to ~3.1-fold higher 30-day MACE after endovascular revascularization for PAD.
Why the study?
The stage-specific influence of chronic kidney disease on perioperative cardiovascular outcomes following endovascular lower extremity revascularization for peripheral artery disease is poorly characterized.
Does advanced chronic kidney disease increase the risk of 30-day MACE in adults undergoing endovascular lower extremity revascularization for peripheral artery disease?
Cohort (n=22,424)
Yes
Does advanced chronic kidney disease increase the risk of 30-day MACE in adults undergoing endovascular lower extremity revascularization for peripheral artery disease?
Odds Ratio: 3.15 (95% CI 2.28–4.35)
Absolute Event Rate: 6% vs 1.5%
Advanced chronic kidney disease exhibits a dose-response relationship with 30-day major adverse cardiovascular events following endovascular lower extremity revascularization for PAD.
Stage 5 CKD was associated with higher 30-day MACE after endovascular PAD revascularization; extends risk stratification data but leaves practice implications open.
OBJECTIVE: Chronic kidney disease (CKD) amplifies cardiovascular risk, yet its stage-specific influence on perioperative outcomes following endovascular lower extremity revascularization (LER) for peripheral artery disease (PAD) remains poorly characterized. METHODS: We conducted a retrospective cohort study using the ACS NSQIP registry (2013-2022). Adults undergoing endovascular LER for PAD were stratified by preoperative estimated glomerular filtration rate (eGFR) via the CKD-EPI 2021 equation: G1 (≥90), G2 (60-89), G3 (30-59), G4 (15-29), and G5 (<15 mL/min/1.73 m2 or dialysis dependent). The primary outcome was 30-day major adverse cardiovascular events (MACE: myocardial infarction, stroke, or death). Multivariable logistic regression estimated adjusted odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Among 22,424 patients (64.6% aged ≥65 years; 36.1% women), comorbidity burden increased progressively with CKD stage. Within 30 days, 556 patients (2.5%) experienced MACE. Event rates rose stepwise: 1.5% (G1), 1.6% (G2), 2.7% (G3), 4.9% (G4), and 6.0% (G5). After adjustment for age, sex, race/ethnicity, ASA class, admission status, presenting symptoms, and preoperative hematocrit, advanced CKD remained independently associated with MACE: OR 2.30 (95% CI 1.50-3.52) for G4 and OR 3.15 (95% CI 2.28-4.35) for G5 versus G1. CONCLUSION: CKD stage provides independent prognostic information in patients undergoing endovascular LER. Advanced CKD independently predicts 30-day MACE with a dose-response relationship across stages. Preoperative eGFR should be incorporated into perioperative risk stratification protocols to guide cardiovascular optimization and surveillance planning.
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Shah et al. (2026) conducted a cohort in Peripheral artery disease (PAD) requiring endovascular lower extremity revascularization (n=22,424). Advanced chronic kidney disease (Stage G5) vs. Normal renal function (Stage G1, eGFR ≥90) was evaluated on 30-day major adverse cardiovascular events (MACE: myocardial infarction, stroke, or death) (OR 3.15, 95% CI 2.28-4.35). In adults undergoing endovascular revascularization for PAD, stage 5 CKD strongly predicted 30-day MACE compared to stage 1 CKD (6.0% vs 1.5%; OR 3.15; 95% CI 2.28-4.35).
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