Rates of future hemodialysis risk and beneficial outcomes for patients with chronic kidney disease undergoing recanalization of chronic total occlusion

Background: This study aimed to assess the prognosis and deleterious effects of chronic kidney disease (CKD) on future renal function, in patients who had undergone chronic total occlusion-percutaneous coronary intervention (CTO-PCI). Methods: The treatment effects were studied in 739 patients who underwent CTO-PCI. The patients were divided into 3 groups according to estimated glomerular filtration rate (eGFR): non-CKD (eGFR >= 60 ml/min/1.73m(2), n= 562), CKD-1 (45 <= eGFR < 60 ml/min/1.73m(2), n = 90), and CKD-2 (eGFR < 45 ml/min/1.73m(2), n = 87). Future hemodialysis (HD) rates and the prevalence of acute kidney injury (AKI) except for 45 patients undergoing regular HD, and other clinical and prognostic outcomes were compared between the 3 groups. Results: Procedural success rates showed trends toward lower prevalence across the 3 groups (89.5%, 84.4%, and 81.6%, p - 0.060). The prevalence of AKI significantly differed between the 3 groups (4.6%, 8.9%, and 16.7%, p - 0.001), whereas no patients were introduced to regular HD at discharge. During a median follow-up period of 51.2 +/- 28.9 months, newly required HD significantly differed between the 3 groups (0.7%, 0%, and 7.1%, p b 0.001). When compared with unsuccessful CTO-PCI, successful CTO-PCI was found to improve cardiovascular mortality in the non-CKD and CKD-1 (Log-rank test: p= 0.025, p= 0.024, respectively) and to improve both cardiovascular and all-cause mortality in the CKD-2 (Log-rank test: p = 0.027, p = 0.0022, respectively). Conclusions: Although CTO-PCI for patients with advanced CKD was associated with a high risk of future HD introduction, not directly owing to CTO-PCI and AKI, successful treatment of CTO might contribute to better survival benefit regardless of the presence or absence of CKD. (C) 2016 Elsevier Ireland Ltd. All rights reserved.