Kidney Week

Abstract: SA-PO0506

Efficacy and Safety of Revascularization in Patients with Chronic Limb-Threatening Ischemia, Stratified by Kidney Function

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Lee, Jun Young, Yonsei University Wonju College of Medicine, Wonju-si, Gangwon-do, Korea (the Republic of)

Jun Young Lee, MD, PhD

• Parvathinathan, Gomathy, Stanford University School of Medicine, Stanford, California, United States

Gomathy Parvathinathan, MS

• Liu, Sai, Stanford University School of Medicine, Stanford, California, United States

Sai Liu

• Etemadi, Ali, Stanford University School of Medicine, Stanford, California, United States

Ali Etemadi, MD

• Stedman, Margaret R., Stanford University School of Medicine, Stanford, California, United States

Margaret R. Stedman, PhD, MPH

• Chang, Tara I., Stanford University School of Medicine, Stanford, California, United States

Tara I. Chang, MD, MS, FASN

Background

The optimal revascularization strategy for patients with chronic limb-threatening ischemia (CLTI) and chronic kidney disease (CKD) remains unclear. We evaluated whether the efficacy and safety of surgical versus endovascular revascularization differed by kidney function.

Methods

Using data from the BEST-CLI randomized trial, 1,704 patients with CLTI were stratified by baseline estimated glomerular filtration rate (eGFR) into non-CKD (≥90 mL/min/1.73 m2), mild-to-moderate CKD (45–89 mL/min/1.73 m2), and advanced CKD (<45 mL/min/1.73 m2 or dialysis). The primary outcome was major adverse limb events (MALE) or death. Secondary outcomes included all-cause death, major adverse cardiovascular events (MACE), serious adverse events (SAEs), hospitalization with acute kidney injury (AKI), and dialysis. Inverse probability of treatment weighting was applied to adjust for covariates, and results are presented as differences in restricted mean time lost (RMTL, days).

Results

Surgical revascularization was associated with fewer days lost to MALE or death in non-CKD (-127.8 days; 95% CI, -176.1 to -79.6) and mild-to-moderate CKD (-63.2 days; 95% CI, -104.7 to -21.8), but not in advanced CKD (-16.4 days; 95% CI, -78.8 to 46.0; P for interaction = 0.02) (Figure). The effect of surgical revascularization on all-cause mortality was attenuated with increasing CKD severity (P for interaction = 0.01). MACE, SAEs, AKI, and dialysis increased with CKD severity but did not differ by treatment strategy.

Conclusion

The benefit of surgical revascularization diminishes with worsening kidney function, while overall event burden increases, highlighting the need for individualized, kidney function–guided treatment decisions.

Acknowledgment

This manuscript was prepared using BEST-CLI Research Materials obtained from the NHLBI BioLINCC. The content does not necessarily reflect the views of the BEST-CLI investigators or the NHLBI.

Figure. IPTW-weighted cumulative incidence of MALE or death following revascularization stratified by CKD stage.

Funding

• NIDDK Support