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. SUMMARY BACKGROUND DATA ESKD and CLTI commonly cooccur and limited prior work has demonstrated poor outcomes including one-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 two-year survival by treatment using propensity matching. RESULTS Of 1,876,652 records with a CLTI diagnosis, we identified 3,908 patients with ESKD and an incident CLTI diagnosis. Mean age at CLTI diagnosis was 65.7 years and 2,405 (61.5%) were male. 2,696 (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 one year, along with 41.8% major postoperative complications and 52.6% readmissions at 90 days. Comparing two-year survival, we found no differences between the amputation and endovascular cohorts (P=0.08) and between endovascular and open (P=.06). There was superior two-year survival in the open surgery cohort compared to the amputation cohort (P=0.002). CONCLUSIONS Patients living with both ESKD and CLTI experience poor outcomes irrespective of treatment. Exploratory analyses demonstrated that two-year survival among the three principal procedural treatments was similar except for superior survival among patients undergoing open therapy compared to primary amputation.

中文翻译：

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终末期肾病和慢性肢体威胁性缺血患者的结局：一项基于人群的队列研究。


目的 了解终末期肾病 （ESKD） 和慢性肢体威胁性缺血 （CLTI） 患者在无手术治疗、初次截肢、血管内治疗和开放手术后的死亡率和次要结局。摘要 背景数据 ESKD 和 CLTI 通常同时发生，有限的先前工作表明结果不佳，包括尽管接受了治疗，但仍能存活一年。方法 我们对 2016 年 1 月 1 日至 2019 年 12 月 31 日的美国肾脏数据系统数据进行了回顾性全国队列研究，以确定死亡率、主要术后并发症和其他结局。我们进行了一项探索性分析，比较了使用倾向匹配的治疗两年生存率。结果 在 1,876,652 份 CLTI 诊断的记录中，我们确定了 3,908 例 ESKD 患者和一起 CLTI 新发诊断患者。CLTI 诊断的平均年龄为 65.7 岁，其中 2,405 例 （61.5%） 为男性。2,696 例 （69.0%） 未接受手术治疗，609 例 （15.6%） 接受大肢体截肢，439 例 （11.2%） 接受血管内治疗，164 例 （4.2%） 接受开放手术。一年死亡率为 44.9%，主要术后并发症为 41.8%，90 天再入院率为 52.6%。比较两年生存率，我们发现截肢和血管内队列之间 （P=0.08） 以及血管内和开放队列之间 （P=.06） 之间没有差异。与截肢队列相比，开放手术队列的两年生存率更高 （P=0.002）。结论 无论接受何种治疗，ESKD 和 CLTI 患者结局都较差。探索性分析表明，三种主要手术治疗的两年生存率相似，但与初次截肢相比，接受开放治疗的患者生存率更高。