Outcomes Among Patients With End-stage Kidney Disease and Chronic Limb-threatening Ischemia: A Population-based Cohort Study.

Objective: To understand mortality and secondary outcomes in patients with both end-stage kidney disease (ESKD) and chronic limb-threatening ischemia (CLTI) after no procedural treatment, primary amputation, endovascular treatment, and open surgery.

Background: ESKD and CLTI commonly cooccur and limited prior work has demonstrated poor outcomes including 1-year survival despite treatment.

Methods: We conducted a retrospective national cohort study of United States Renal Data System data from January 1, 2016 to December 31, 2019 to determine mortality, major postoperative complications, and other outcomes. We performed an exploratory analysis comparing 2-year survival by treatment using propensity matching.

Results: Of 1,876,652 records with a CLTI diagnosis, we identified 3908 patients with ESKD and an incident CLTI diagnosis. The mean age at CLTI diagnosis was 65.7 years and 2405 (61.5%) were males. Of the total, 2696 (69.0%) had no procedural treatment, 609 (15.6%) had major limb amputation, 439 (11.2%) had endovascular treatment, and 164 (4.2%) had open surgery. There was 44.9% mortality at 1 year, along with 41.8% major postoperative complications and 52.6% readmissions at 90 days. Comparing 2-year survival, we found no differences between the amputation and endovascular cohorts ( P = 0.08) and between endovascular and open ( P = 0.06). There was superior 2-year survival in the open surgery cohort compared with the amputation cohort ( P = 0.002).

Conclusions: Patients living with both ESKD and CLTI experience poor outcomes irrespective of treatment. Exploratory analyses demonstrated that 2-year survival among the 3 principal procedural treatments was similar except for superior survival among patients undergoing open therapy compared with primary amputation.