Risks and outcomes of critical limb ischaemia in haemodialysis patients: a prospective cohort study


 
 
 Peripheral arterial disease (PAD) is more common in patients receiving maintenance haemodialysis than in the general population. Critical limb ischaemia, the most severe form of PAD, is associated with high amputation and mortality risk. However, few prospective studies are available evaluating this disease's presentation, risk factors, and outcomes for patients receiving haemodialysis.
 
 
 
 The Hsinchu VA study, a prospective multicentre study, investigated the impact of clinical factors on cardiovascular outcomes of patients receiving maintenance haemodialysis from January 2008 until December, 2021. We evaluated the presentations and outcomes of patients with newly diagnosed PAD and the correlations of clinical variables with newly diagnosed critical limb ischaemia.
 
 
 
 Of 1136 study participants, 1038 had no PAD on enrolment. After a median follow-up period of 3.3 years, 128 had newly diagnosed PAD. Of these, 65 presented with critical limb ischaemia, and 25 underwent amputation or died from PAD. Patients presenting with critical limb ischaemia had more below-the-knee (52%) and multi-level (41%) disease, completely occluded segments (41%), and higher risk for amputation or PAD-related death compared with patients without critical limb ischaemia (27.7% vs. 9.5%, P = 0.01). After multivariate adjustment, disability, diabetes mellitus, current smoking, and atrial fibrillation were significantly associated with newly diagnosed critical limb ischaemia.
 
 
 
 Patients undergoing haemodialysis had higher rates of newly diagnosed critical limb ischaemia than the general population. Those with disabilities, diabetes mellitus, smoking, and atrial fibrillation may require careful examination for PAD. Hsinchu VA study, ClinicalTrials.gov identifier: NCT04692636.
