Kidney Week

Abstract: SA-PO340

Open vs. Endovascular Revascularization for Chronic Limb-Threatening Ischemia in CKD

Session Information

• Hypertension, CVD, and the Kidneys: Clinical Research
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Tuttle, Katherine R., University of Washington School of Medicine, Seattle, Washington, United States

Katherine R. Tuttle, MD, FASN

• Hamouda, Mohammed, University of California San Diego, La Jolla, California, United States

Mohammed Hamouda, MD

• Menard, Matthew T., Brigham and Women's Hospital, Boston, Massachusetts, United States

Matthew T. Menard, MD

• Strong, Michael Bernard, Brigham and Women's Hospital, Boston, Massachusetts, United States

Michael Bernard Strong, MA

• Doros, Gheorghe, Boston University, Boston, Massachusetts, United States

Gheorghe Doros, PhD, MBA

• Farber, Alik, Boston University, Boston, Massachusetts, United States

Alik Farber, MD

• Malas, Mahmoud, University of California San Diego, La Jolla, California, United States

Mahmoud Malas, MD, MHS

Group or Team Name

• On behalf of the BEST-CLI Trial.

Background

Chronic kidney disease (CKD) increases risk of chronic limb threatening ischemia (CLTI). We assessed relationships between estimated glomerular filtration rate (eGFR) and clinical outcomes by surgical versus endovascular revascularization.

Methods

The Best Endovascular versus Surgical Therapy in Patients with CLTI (BEST-CLI) trial enrolled patients with CLTI inclusive of those with CKD. Spline modeling was performed across the range of eGFR observed in study participants to assess hazard ratios (HRs) for major adverse limb events (MALE: above ankle amputation, limb reintervention) or death, the primary trial outcome, by randomized assignment. Multiple variable Cox models were used to predict risks of MALE or death.

Results

At baseline, the mean±SD age was 67.4±9.7 years, 28.5% (500/1756) were women, and 27.5% (478/1740) identified as non-White race. CKD was present in 28.4% (499/1754). At eGFR <30 mL/min/1.73m², the HR for MALE or death increased with no difference in the primary outcome by randomized surgical versus endovascular revascularization (Figure). In adjusted Cox models, the HRs (95% confidence interval) for eGFR <30 versus >60 mL/min/1.73m² were 2.03 (1.68-2.43, p<0.001) and 3.46 (2.80-4.27, p<0.001) for MALE and death, respectively. In subgroup analyses by the same eGFR strata, antiplatelet agent non-users had increased risk of the primary outcome (HR 2.58, 1.71-3.89, p<0.001) versus no risk increase in users.

Conclusion

In patients with CLTI, risks of MALE and death increased sharply at eGFR <30 mL/min/1.73m² with no difference in the primary outcome by surgical or endovascular revascularization. Use of antiplatelet agents may mitigate risks of MALE and death in this high-risk population.

Funding

• Other NIH Support – Novo Nordisk