The Impact of Chronic Kidney Disease on Amputation and Death Rates in Patients with Peripheral Artery Disease in the United States

Abstract

Purpose

To quantify and characterize how advancing stages of chronic kidney disease (CKD) affect the incidence of amputation and death among patients with peripheral artery disease (PAD) in the United States.

Materials and Methods

The Premier Healthcare Database was used and included data from 8.5 million hospitalizations between 2016 and 2021. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to identify clinical conditions and comorbidities.

Results

A total of 874,788 patients with PAD were included, of which 106,956 (12.2%) had CKD. Among these patients, 6.2% had CKD Stages 1 and 2, 52.6% had CKD Stages 3 and 4, and 41.1% had CKD Stage 5. Amputation rates increased significantly with advancing stages of CKD (CKD Stage 0, 7.8%; CKD Stages 1 and 2, 20.1%; CKD Stages 3 and 4, 19.5%; CKD Stage 5, 31.3%; P < .0001). In subgroup analyses, patients who had PAD, CKD Stage 5, and diabetes mellitus (DM) had an amputation rate of 36.5%. The mortality rate among patients with PAD increased significantly with advancing stages of CKD (CKD Stage 0, 0.9%; CKD Stages 1 and 2, 2.7%; CKD Stage 3 and 4, 3.7%; CKD Stage 5, 4.7%; P < .0001).

Conclusions

Patients with PAD and CKD Stage 5 had 4 times higher amputation rates (31.3% vs 7.8%) and 5 times higher mortality (4.7% vs 0.9%) compared with patients with PAD without CKD. Patients with PAD, CKD Stage 5, and DM had the highest amputation rate among the groups studied (36.5%).