所属 医学部 医学科（東京女子医科大学病院） 職種 講師
|発表タイトル||Anemia Worsened Long Term Prognosis in Peripheral Artery Disease Patients With Mildly Reduced but Not With Severely Reduced Renal Functions|
|会議名||American Heart Association (AHA) Scientific Sessions 2018|
|主催者||American Heart Association|
|発表者・共同発表者||◎MIZOBUCHI Keiko, JUJO Kentaro, MINAMI Yuichiro, ISHIDA Issei, HARUKI Shintaro, AKASHI Madoka, NAKAO Masashi, HAGIWARA Nobuhisa|
|学会抄録||Circulation 138(Suppl 1),Abstract 11381 2018|
|概要||*Session Title: Genetic and Enzymatic Regulation of Atherosclerosis
Introduction: Patients with peripheral artery disease (PAD) are at advanced stage of atherosclerosis, and had diverse comorbidities. Especially, chronic kidney disease (CKD) is highly prevalent in PAD patients, and is associated with poor prognosis. Majority of CKD patients have renal anemia, and the morbidity of anemia is adversely affects the survival rate in PAD patients.
Hypothesis: The prognostic implication of anemia depends on the severity of CKD in patients after endovascular therapy (EVT).
Methods: Total of 720 consecutive patients who received EVT between 2013 and 2017 was initially included in this study. After the exclusion of patients with CKD grade 1/2, 494 patients were ultimately enrolled, and they were divided into 4 groups depending on the degree of CKD and the presence of anemia; the mild-CKD/Non-anemia group, mild-CKD/Anemia group, severe-CKD/Non-anemia group, and severe-CKD/Anemia group. Mild-CKD was defined as estimated glomerular filtration rate (eGFR) of 30-60 ml/min/1.73m2, and severe-CKD was eGFR <30 ml/min/1.73m2. Anemia was defined as hemoglobin level <11 g/dl at the time of EVT. The primary endpoint was major amputation-free survival (AFS).
Results: During 557 days of median follow-up after EVT, there were 114 events, including 77 deaths and 37 major amputations. Kaplan-Meier analysis revealed that the severe-CKD/Anemia and severe-CKD/Non-anemia group did not show a significantly different AFS rate; while, the mild-CKD/Anemia group showed a significantly higher AFS rate compared to the mild-CKD/Non-anemia group (Figure). In multivariate Cox regression analysis, mild-CKD/Anemia group showed a significantly higher hazard ratio (HR) compared to the mild-CKD/Non-Anemia group even after adjustment for other comorbidities (HR: 6.01, 95% confidence interval 2.03-17.8, p=0.001).
Conclusions: Anemia increased AFS rate in PAD patients with mild-CKD, but not in those with severe-CKD after EVT.