Comparative Outcomes of Carotid Artery Stent Placement and Carotid Endarterectomy in Patients with Chronic Kidney Disease and End-Stage Renal Disease

Background Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have a high prevalence of carotid artery stenosis but are excluded from clinical trials. We sought to determine the clinical characteristics and outcomes related to carotid endarterectomy (CEA) and carotid artery stenting (CAS) in ESRD and CKD patients. Methods We determined the frequency of CAS and CEA performed in patients with ESRD and CKD and associated in-hospital outcomes using data from the nationwide inpatient sample data files from 2005 to 2011. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Results Of the 43,875 CKD patients who underwent CEA, 3888 (8.8%) were ESRD patients. After adjusting for age, gender, race, presence of hypertension, congestive heart failure (CHF), dyslipidemia, nicotine dependence and alcohol abuse, CEA performed in ESRD patients was associated with higher rates of in-hospital mortality (odds ratio [OR] 4.3, 95% confidence interval [CI] 2.1-9.0; P ≤.0001) and moderate to severe disability (OR 1.4, 95% CI 1.1-1.8; P =.009). Of the 8148 CKD patients who underwent CAS, 693 (8.5%) were ESRD patients. After adjusting for age, gender, race/ethnicity, presence of dyslipidemia, CHF, and hypertension, CAS performed in ESRD patients was associated with higher rates of in-hospital mortality (OR 3.7, 95% CI 1.0-13.9; P =.04) and moderate to severe disability (OR 1.7, 95% CI 1.0-3.3; P =.05). Conclusions Both CAS and CEA were associated with 4-folds higher odds of in-hospital mortality in ESRD patients and such observations raise concerns regarding the risk: benefit ratio of carotid revascularization in these patients.