Peripheral artery disease: CKD tied to excess risk for CV events

  • Hopley CW & al.
  • Vasc Med
  • 24/07/2019

  • Yael Waknine
  • Clinical Essentials
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Takeaway

  • Comorbid chronic kidney disease (CKD) is associated with excess risk for cardiovascular (CV) ischemic events and all-cause mortality in patients with peripheral arterial disease (PAD).

Why this matters

  • Risk increases with degree of renal impairment.

Study design

  • Post hoc analysis of the EUCLID randomized trial involving 13,483 patients with PAD receiving ticagrelor (Brilinta) or clopidogrel (Plavix).
  • 3332 (24.7%) had comorbid CKD (stage 4/5, n=237).
  • Primary composite endpoint: CV death, myocardial infarction (MI), or ischemic stroke.
  • Median follow-up, ~30 months.
  • Funding: AstraZeneca.

Key results

  • CKD was associated with a higher rate of the primary endpoint vs no CKD (6.75 vs 3.72 events/100 patient-years), corresponding to a 45% increased risk (adjusted [a]HR, 1.45; P<.0001 style="list-style-type:circle;">
  • Risk rose 20% with each 10 mL/minute/1.73 m2 decrease in estimated glomerular filtration rate below 70 mL/minute/1.73 m2 (HR, 1.20; P<.0001>
  • The effect appeared driven by CV death (aHR, 1.42; P=.0001) and MI (aHR, 1.55; P<.0001 rather than ischemic stroke>
  • All-cause mortality also increased (aHR, 1.40; P<.0001>
  • CKD was associated with a 51% elevated risk for minor bleeding (aHR, 1.51; P=.0205), but not major bleeding (P=.2220).
  • No association observed with hospitalization for acute limb ischemia (P=.8074), major amputation (P=.6371), or their composite (P=.9082).
  • Limitations

    • Few major bleeding events.