Research article

Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

Christine M Logar² , Lisa M Pappas² , Nirupama Ramkumar² and Srinivasan Beddhu^1,2

¹Renal Section, Salt Lake VA Healthcare System, University of Utah School of Medicine, Salt Lake City, UT, USA

²Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA

author email corresponding author email

BMC Nephrology 2005, 6:3doi:10.1186/1471-2369-6-3

Published:	21 March 2005

Abstract

Background

Surgical treatment of peripheral vascular disease (PVD) in dialysis patients is controversial.

Methods

We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation.

Results

Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896) or amputation (n = 2,046) in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR) 19.0, 95% CI (confidence interval) 13.86–25.95]. The odds of dying within 30 days and within1 year were higher (30 day OR: 1.85, 95% CI: 1.45–2.36; 1 yr OR: 1.46, 95% CI: 1.25–1.71) in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (< 33^rd percentile of propensity score) and moderate likelihood of amputation (33^rd to 66^th percentile) but not in high likelihood group (>66^th percentile). The number of hospital days in the amputation and revascularization groups was not different.

Conclusion

Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.