Impact of CKD on cardiovascular events and mortality in peripheral artery disease

Takeaway

• Patients with peripheral artery disease (PAD) and chronic kidney diseases (CKD) had higher rates of cardiovascular deaths, myocardial infarction (MI) and all-cause mortality rates compared with those without CKD.
• Similar rates of major bleeding, acute limb ischaemia (ALI) and major amputation were observed between PAD patients with CKD and those without CKD.

Why this matters

• CKD is commonly associated with cardiovascular disease and worse outcomes in patients with PAD.
• The effect of CKD and the severity of renal impairment on cardiovascular ischaemic events and all-cause mortality in patients with PAD has not been fully assessed.

Study design

• Post hoc analysis of the Examining Use of Ticagrelor In PAD (EUCLID) trial included 13,885 patients with symptomatic PAD who were randomly assigned to receive ticagrelor 90 mg twice daily or clopidogrel 75 mg daily.
• Primary composite endpoint (cardiovascular death, MI or ischaemic stroke) was compared in patients with CKD (estimated glomerular filtration rate [eGFR], <60 mL/min/1.73 m²) vs those without CKD (eGFR, ≥60 mL/min/1.73 m²).
• Funding: AstraZeneca.

Key results

• 25% of the patients had CKD, of which 14% had stage IV/V disease.
• Median follow-up was approximately 30 months.
• Patients with CKD vs those without CKD had significantly higher rate of:
  • primary composite endpoint (6.75 vs 3.72 events/100 patient-years; adjusted HR [aHR], 1.45; 95% CI, 1.30-1.63; P<.0001).
  • all-cause mortality (5.41 vs 3.02 events/100 patient-years; aHR, 1.40; 95% CI, 1.24-1.59; P<.0001).
  • minor bleeding (0.73 vs 0.46 events/100 patient-years; aHR, 1.51; 95% CI, 1.07-2.15; P=.0205).
• CKD was not associated with increased risk for:
  • ALI-related hospitalisation (aHR, 0.96; 95% CI, 0.69-1.34; P=.8074),
  • major amputation (aHR, 0.92; 95% CI, 0.66-1.28; P=.6371), and
  • major bleeding (aHR, 1.21; 95% CI, 0.89-1.64; P=.2220).

Limitations

• Post hoc analysis.