Print this pageChronic kidney disease and the outcomes of carotid interventions: Do stage and GFR matter?
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Andrew M. Bakken, MD1, Clinton D. Protack, BS1, Joseph P. Hart, MD1, Wael E. Saad, MD1, Jeffrey M. Rhodes, MD1, Mark G. Davies, MD, PhD2.
1University of Rochester, Rochester, NY, USA, 2Methodist Debakey Heart Center, The Methodist Hospital, Houston, TX, USA.
Objectives: Chronic kidney disease (CKD) is implicated as an important risk factor in the natural history of cerebrovascular disease. Its importance in the outcomes of carotid interventions, whether carotid endarterectomy (CEA) or carotid artery stenting (CAS), has not been defined based on currently defined kidney disease stratification. This study examines the outcomes of carotid interventions based on CKD as defined by NKF (National Kidney Foundation) stages at an academic medical center.
Methods: A database of patients undergoing CEA and CAS was maintained from 2001 to 2005. Glomerular filtration rate (GFR - ml/min/1.73 m2) was estimated based on the abbreviated Modification of Diet in Renal Disease equation. Groups were analyzed by Stages 0-2 (GFR > 60) vs Stages 3-5 (GFR < 60) and Stages 0-3 (GFR >30) vs Stages 4-5 (GFR < 30). Kaplan-Meier analyses were performed to assess time-dependent outcomes.
Results: 486 (61% male) vessels underwent CEA and 201 (61% male) underwent CAS. Among those having CEA, the percent with kidney disease by stage were 27% (Stage 0-1), 49% (Stage 2), 20% (Stage 3), 2% (Stage 4), and 2% (Stage 5). For CAS, kidney disease stages were 29% (Stage 0-1), 40% (Stage 2), 26% (Stage 3), 4% (Stage 4), and 1% (Stage 5). Analyzed at the breakpoint of GFR >/< 60 (Table) or GFR >/< 30, neither CEA or CAS differed significantly in follow-up with respect to patency, restenosis, strokes, reinterventions, or 30-day mortality (P > 0.05 for all outcomes).
| Table | CEA (NKF Stages 0-2) | CEA (NKF Stages 3-5) | p-value | CAS (NKF Stages 0-2) | CAS (NKF Stages 3-5) | p-value |
| N | 367 | 119 | - | 138 | 63 | - |
| Asymptomatic | 55% | 59% | ns | 49% | 44% | ns |
| Primary Patency (%)* | 94 ± 2 | 95 ± 3 | ns | 91 ± 3 | 87 ± 4 | ns |
| Free of Restenosis (%)* | 78 ± 3 | 77 ± 4 | ns | 75 ± 5 | 74 ± 7 | ns |
| Stroke Free Rate (%)* | 92 ± 2 | 96 ± 2 | ns | 81 ± 3 | 86 ± 4 | ns |
| Free of Re-Intervention (%)* | 95 ± 2 | 95 ± 3 | ns | 94 ± 2 | 96 ± 3 | ns |
| 30-d Mortality (%) | 0 | 0 | ns | 1 ± 1 | 1 ± 1 | ns |
*Data are presented as mean ± SEM at 3 yrs
Conclusions: CKD is prevalent among the patients undergoing carotid interventions. Stage of kidney disease as defined by GFR does not impact procedural outcomes irrespective of the mode of intervention (CEA or CAS) and should not determine the mode of intervention.
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