Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

• Main Authors: Ramkumar Nirupama, Pappas Lisa M, Logar Christine M, Beddhu Srinivasan
• Format: Article
• Language: English
• Published: BMC 2005-03-01
• Series: BMC Nephrology
• Online Access: http://www.biomedcentral.com/1471-2369/6/3

<p>Abstract</p> <p>Background</p> <p>Surgical treatment of peripheral vascular disease (PVD) in dialysis patients is controversial.</p> <p>Methods</p> <p>We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation.</p> <p>Results</p> <p>Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896) or amputation (n = 2,046) in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR) 19.0, 95% CI (confidence interval) 13.86–25.95]. The odds of dying within 30 days and within1 year were higher (30 day OR: 1.85, 95% CI: 1.45–2.36; 1 yr OR: 1.46, 95% CI: 1.25–1.71) in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (< 33^rdpercentile of propensity score) and moderate likelihood of amputation (33^rdto 66^thpercentile) but not in high likelihood group (>66^thpercentile). The number of hospital days in the amputation and revascularization groups was not different.</p> <p>Conclusion</p> <p>Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.</p>