Systematic Review and Meta-Analysis of the Effect of Chronic Kidney Disease on Amputation and Mortality in Patients With Peripheral Artery Disease
Bibliographic record
Abstract
Background The influence of presence/absence chronic kidney disease (CKD) on the clinical course and outcomes of patients with peripheral artery disease (PAD) has not been extensively investigated. We aimed to measure the relative rates of amputation and mortality in individuals with different stages of CKD compared to those without CKD, and to assess whether revascularization treatments might reduce these risks for PAD patients. Methods We conducted a thorough search of the literature across multiple databases, including MEDLINE, EMBASE, the Cochrane Library, and Web of Science. The risk of bias assessment was assessed using the Newcastle-Ottawa Quality Assessment scale. All studies that reported relevant results in PAD patients were included. The statistical analysis involved the calculation of pooled prevalence estimates using a random-effects model, along with the performance of subgroup analyses and meta-regression to evaluate heterogeneity. Results We included fourteen observational studies encompassing a total of 554,270 patients with PAD that met the predefined inclusion criteria. Eleven studies reported on amputation rates in patients with and without CKD. Our analysis showed that CKD patients faced nearly double the risk of amputation compared to those without CKD (1.94; 1.90 to 1.97; P < 0.001; I 2 = 96.8%, P < 0.001). Additionally, a significant rise in mortality risk among CKD patients was observed across 14 studies, in comparison to patients without CKD (OR 2.04; 95% CI 1.99 to 2.08; P < 0.001; I 2 = 78.6%, P < 0.001). Moreover, we observed a graded increase in both amputation and mortality rates with the progression of CKD severity. In terms of therapeutic interventions, the potential of revascularization procedures to lower mortality and amputation rates appeared to be attenuated in the presence of CKD in PAD patients. Meta-regression analysis revealed that only a baseline diabetic population exceeding 50% exhibited a borderline association with amputation rate (β 0.422; 95% CI [-0.189; 1.035]) after adjusting for other covariates, including sample size, percentage of patients with critical limb ischemia, and follow-up time. Conclusion The significant association noted between CKD and risk of amputation and mortality with PAD, with this risk intensifying as renal insufficiency progresses. Furthermore, the effectiveness of revascularization procedures in reducing amputation and mortality rates is diminished in patients with PAD who also have CKD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.050 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.022 | 0.038 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".