Rates of future hemodialysis risk and beneficial outcomes for patients with chronic kidney disease undergoing recanalization of chronic total occlusion

详细信息    查看全文

• 作者：Tetsuro Shimura ; MD^a ; Masanori Yamamoto ; MD^a ; ^{yamamoto@heart-center.or.jp" class="auth_mail" title="E-mail the corresponding author} ; Etsuo Tsuchikane ; MD^a ; ^{tsuchikane@heart-center.or.jp" class="auth_mail" title="E-mail the corresponding author} ; Tomohiko Teramoto ; MD^a ; Masashi Kimura ; MD^a ; Hitoshi Matsuo ; MD^b ; Yoshiaki Kawase ; MD^b ; Yoriyasu Suzuki ; MD^c ; Seiji Kano ; MD^c ; Maoto Habara ; MD^a ; Kenya Nasu ; MD^a ; Yoshihisa Kinoshita ; MD^a ; Mitsuyasu Terashima ; MD^a ; Tetsuo Matsubara ; MD^a ; Takahiko Suzuki ; MD^a
• 关键词：Coronary artery disease ; Chronic kidney disease ; Chronic total occlusion ; Percutaneous coronary intervention ; Hemodialysis
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：222
• 期：Complete
• 页码：707-713
• 全文大小：560 K

文摘

This study aimed to assess the prognosis and deleterious effects of chronic kidney disease (CKD) on future renal function, in patients who had undergone chronic total occlusion-percutaneous coronary intervention (CTO-PCI).

Methods

The treatment effects were studied in 739 patients who underwent CTO-PCI. The patients were divided into 3 groups according to estimated glomerular filtration rate (eGFR): non-CKD (eGFR ≥ 60 ml/min/1.73m², n = 562), CKD-1 (45 ≤ eGFR < 60 ml/min/1.73m², n = 90), and CKD-2 (eGFR < 45 ml/min/1.73m², n = 87). Future hemodialysis (HD) rates and the prevalence of acute kidney injury (AKI) except for 45 patients undergoing regular HD, and other clinical and prognostic outcomes were compared between the 3 groups.

Results

Procedural success rates showed trends toward lower prevalence across the 3 groups (89.5%, 84.4%, and 81.6%, p = 0.060). The prevalence of AKI significantly differed between the 3 groups (4.6%, 8.9%, and 16.7%, p = 0.001), whereas no patients were introduced to regular HD at discharge. During a median follow-up period of 51.2 ± 28.9 months, newly required HD significantly differed between the 3 groups (0.7%, 0%, and 7.1%, p < 0.001). When compared with unsuccessful CTO-PCI, successful CTO-PCI was found to improve cardiovascular mortality in the non-CKD and CKD-1 (Log-rank test: p = 0.025, p = 0.024, respectively) and to improve both cardiovascular and all-cause mortality in the CKD-2 (Log-rank test: p = 0.027, p = 0.0022, respectively).

Conclusions

Although CTO-PCI for patients with advanced CKD was associated with a high risk of future HD introduction, not directly owing to CTO-PCI and AKI, successful treatment of CTO might contribute to better survival benefit regardless of the presence or absence of CKD.