Serum albumin and C-reactive protein levels predict clinical outcome in hemodialysis patients undergoing endovascular therapy for peripheral artery disease

Abstract

Objective: Peripheral artery disease (PAD) is frequently seen in hemodialysis patients, endovascular therapy (EVT) often being performed in such cases. We examined combined prognostic utility of pre-procedural serum albumin and C-reactive protein (CRP) in combination for predicting clinical outcome after EVT in HD patients with PAD.

Methods: A total of 450 hemodialysis patients successfully undergoing EVT for PAD were followed-up for up to 8 years. They were divided according to median serum albumin and CRP levels measured prior to EVT into four groups [those with high albumin and low and high CRP levels, respectively, and low albumin and low and high CRP levels, respectively]. We analyzed the incidence of major adverse events (MAE) as a composite endpoint including target lesion revascularization (TLR), amputation and all-cause death, and major adverse limb events (MALE) as a composite endpoint including TLR and amputation.

Results: During the follow-up period (36 ± 31months), 206 MAE (46%) including 67 TLR, 45 amputations and 94 deaths occurred. Event-free survival rates from MAE for 8 years were 41.9%, 21.2%, 29.8%, and 13.2% in groups with high albumin and low CRP levels, with high albumin and high CRP levels, with low albumin and low CRP levels, and with low albumin and high CRP levels, respectively (P = 0.0001). Similar tendency was also seen in incidence of MALE (P < 0.0001).

Conclusion: Lower albumin and elevated CRP levels could strongly predict MAE and MALE after EVT in hemodialysis patients.