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Combined Prognostic Value of Pre-procedural Protein-Energy Wasting and Inflammation Status for Amputation and/or Mortality After Lower Extremity Revascularization in Hemodialysis Patients With Peripheral Arterial Disease
Kumada, Y.; Kawai, N.; Ishida, N.; Nakamura, Y.; Takahashi, H.; Ohshima, S.; Ito, R.; Izawa, H.; Murohara, T.; Ishii, H. Combined Prognostic Value of Preprocedural Protein–Energy Wasting and Inflammation Status for Amputation and/or Mortality after Lower-Extremity Revascularization in Hemodialysis Patients with Peripheral Arterial Disease. J. Clin. Med.2024, 13, 126.
Kumada, Y.; Kawai, N.; Ishida, N.; Nakamura, Y.; Takahashi, H.; Ohshima, S.; Ito, R.; Izawa, H.; Murohara, T.; Ishii, H. Combined Prognostic Value of Preprocedural Protein–Energy Wasting and Inflammation Status for Amputation and/or Mortality after Lower-Extremity Revascularization in Hemodialysis Patients with Peripheral Arterial Disease. J. Clin. Med. 2024, 13, 126.
Kumada, Y.; Kawai, N.; Ishida, N.; Nakamura, Y.; Takahashi, H.; Ohshima, S.; Ito, R.; Izawa, H.; Murohara, T.; Ishii, H. Combined Prognostic Value of Preprocedural Protein–Energy Wasting and Inflammation Status for Amputation and/or Mortality after Lower-Extremity Revascularization in Hemodialysis Patients with Peripheral Arterial Disease. J. Clin. Med.2024, 13, 126.
Kumada, Y.; Kawai, N.; Ishida, N.; Nakamura, Y.; Takahashi, H.; Ohshima, S.; Ito, R.; Izawa, H.; Murohara, T.; Ishii, H. Combined Prognostic Value of Preprocedural Protein–Energy Wasting and Inflammation Status for Amputation and/or Mortality after Lower-Extremity Revascularization in Hemodialysis Patients with Peripheral Arterial Disease. J. Clin. Med. 2024, 13, 126.
Abstract
Background: Although lower extremity revascularization is commonly performed in hemodialysis patients, poor prognosis remains a major problem. Protein-energy wasting is reportedly associated with chronic inflammation and advanced atherosclerosis in hemodialysis patients. We investigated the association between the geriatric nutritional risk index (GNRI) as a surrogate marker of protein-energy wasting, C-reactive protein (CRP), and their joint roles in the prediction of amputation and/or mortality. Methods: We enrolled 800 patients successfully underwent lower extremity revascularization. Patients were divided into low, middle and high tertile (T1, T2 and T3) according to GNRI and CRP levels, respectively. Results: Amputation-free survival rates for 8 years were 47.0%, 56.9%, and 69.5% in T1, T2, and T3 of the GNRI, and 65.8%, 58.7%, and 33.2% for T1, T2, and T3 of CRP, respectively (p<0.0001 for both). Declined GNRI [adjusted hazard ratio (aHR) 1.78, 95% confidence interval (CI) 1.24-2.59, p=0.0016 for T1 vs. T3] and elevated CRP (aHR 1.86, 95%CI 1.30-2.70, p=0.0007 for T3 vs. T1) were independent predictors of amputation and/or mortality. In the combined setting of both variables, the risk was 3.77-fold higher (95% CI 1.97-7.69, p<0.0001) in the T1 of GNRI with T3 of CRP than in the T3 of GNRI with T1 of CRP. Conclusions: Patients with pre-procedural decreased GNRI and elevated CRP levels frequently experienced amputation and/or mortality, and a combination of both variables could more accurately stratify the risk.
Public Health and Healthcare, Public Health and Health Services
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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