PAD Patients with ESRD Face Higher Cardiovascular Risks After Endovascular Therapy: Study Finds

"Patients with both PAD and ESRD undergoing lower limb EVT faced significantly higher risks of major cardiac and cerebrovascular events (HR 3.88), myocardial infarction (HR 2.14), and all-cause mortality (HR 2.89) compared to those without ESRD. Major adverse limb event rates were similar between groups. Notably, ESRD independently predicted MACCE risk (HR 2.49)," the researchers reported.

The retrospective cohort study assessed the impact of ESRD on both systemic and localized outcomes in symptomatic PAD patients undergoing EVT. The researchers reviewed data from patients treated between May 2018 and May 2021 at a tertiary medical center and categorized them based on ESRD status. To ensure comparability, a propensity score-matched (PSM) analysis was performed, accounting for potential confounders such as comorbidities and baseline characteristics.

The study’s primary focus was on major adverse cardiac and cerebrovascular events (MACCEs), while major adverse limb events (MALEs) served as the secondary outcome.

The key findings include the following:

• PAD patients with ESRD showed significantly higher rates of major adverse cardiac and cerebrovascular events (MACCEs), myocardial infarction (MI), and all-cause mortality compared to those without ESRD after matching.
• In the matched cohort, the risk of MACCEs was nearly four times higher in ESRD patients (HR: 3.88) than in non-ESRD patients.
• The risk of myocardial infarction was more than twice as high in ESRD patients (HR: 2.14).
• The likelihood of all-cause mortality was nearly three times higher in ESRD patients (HR: 2.89).
• ESRD was the only independent predictor significantly linked to increased MACCE risk (HR: 2.49).
• Although major adverse limb events (MALEs) were more frequent among ESRD patients in the full cohort (61.0% vs. 34.9%), this difference was not statistically significant after matching (HR: 1.23).
• The findings suggest that ESRD alone may not independently increase the risk of limb-specific complications following EVT.

The authors emphasized that the findings highlight the need for increased clinical vigilance in patients with peripheral artery disease (PAD) and end-stage renal disease (ESRD) undergoing endovascular therapy (EVT). Given the substantially elevated risk of systemic complications, particularly major adverse cardiac and cerebrovascular events (MACCEs) and myocardial infarction (MI), they underscored the importance of proactive cardiovascular risk management in this vulnerable population.

They further noted that ESRD significantly worsens systemic outcomes in PAD patients treated with EVT, even though the risk of limb-related adverse events remains comparable after adjusting for confounding variables.

“These insights,” the authors concluded, “could help guide clinicians toward more personalized interventions and comprehensive care strategies aimed at minimizing cardiovascular complications in this high-risk group.”

Reference:

Tsai, SY., Huang, TY., Li, HY. et al. Systemic outcomes of symptomatic peripheral artery disease patients with end-stage renal disease undergoing lower limb endovascular treatment: a propensity score-matched analysis. BMC Cardiovasc Disord 25, 388 (2025). https://doi.org/10.1186/s12872-025-04838-x