KLI

Impact of Chronic Kidney Disease Under Nephrology Care on Outcomes of Carotid Endarterectomy

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Abstract
Objective: This study aimed to investigate the impact of chronic kidney disease (CKD) and the delivery of nephrology care on outcomes of carotid endarterectomy (CEA).

Methods: This was a single centre, retrospective observational study. Between January 2007 and December 2014, 675 CEAs performed on 613 patients were stratified by pre-operative estimated glomerular filtration rate (eGFR) values (CKD [eGFR < 60 mL/min/1.73m(2)] and non-CKD [eGFR = 60 mL/min/1.73m(2)] groups) for retrospective analysis. The study outcomes included the occurrence of major adverse cardiovascular events (MACEs), defined as fatal or non-fatal stroke, myocardial infarction, or all cause mortality, during the peri-operative period and within four years after CEA.

Results: The CKD group consisted of 112 CEAs (16.6%), and the non-CKD group consisted of 563 CEAs (83.4%). The MACE incidence was higher among patients with CKD compared with non-CKD patients during the peri-operative period (4.5% vs. 1.8%; p = .086) and within four years after CEA (17.9% vs. 11.5%; p = .066), with a non-statistically significant trend. In a subgroup analysis of patients with CKD under nephrology care (63/112, 56.3%; with better controlled risk factors and tighter medical surveillance by a nephrologist), patients with CKD without nephrology care (49/112, 43.8%), and non-CKD patients, the risk of both peri-operative (4.1% vs. 0.4%; p = .037) and four year post-operative (20.4% vs. 7.3%; p = .004) all cause mortality was statistically significantly higher among patients with CKD without nephrology care compared with non-CKD patients. However, there were no statistically significant differences between patients with CKD who received nephrology care and non-CKD patients in peri-operative and four year post-operative MACE occurrence, both in terms of the composite MACE outcome and the individual MACE components.

Conclusion: Despite the higher risk of peri-operative and four year MACE after CEA among patients with CKD, and the statistically significantly higher peri-operative and four year post-operative all cause mortality rates among patients with CKD without nephrology care, patients with CKD under nephrology care had similar outcomes to non-CKD patients.
Author(s)
정민재변은애장재원권순억김나영최얼한영진권태원조용필
Issued Date
2021
Type
Article
Keyword
Carotid EndarterectomyChronic Kidney DiseaseOutcomes
DOI
10.1016/j.ejvs.2021.01.013
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8082
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2494294268&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Impact%20of%20Chronic%20Kidney%20Disease%20Under%20Nephrology%20Care%20on%20Outcomes%20of%20Carotid%20Endarterectomy&amp;offset=0&amp;pcAvailability=true
Publisher
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Location
영국
Language
영어
ISSN
1078-5884
Citation Volume
61
Citation Number
5
Citation Start Page
739
Citation End Page
746
Appears in Collections:
Medicine > Medicine
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