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Abstract 166: Carotid Artery Stent Placement and Carotid Endarterectomy in Patients with Dialysis Dependent Renal Failure


 Background:
 Patients with dialysis dependent renal failure (DDRF) have a high prevalence of carotid artery stenosis. These patients are excluded from clinical trials evaluating carotid artery stent placement (CAS) and carotid endarterectomy (CEA).
 
 
 Objective:
 To identify differences in demographic and clinical characteristics and outcomes related to CAS and CEA in DDRF and non DDRF patients in a large national cohort.
 
 
 Methods:
 We determined the frequency of CAS and CEA performed in DDRF and non DDRF patients and associated in-hospital outcomes using data from the Nationwide Inpatient Survey (NIS) data files from 2005 to 2011. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis.
 
 
 Results:
 Of the 8148 patients who underwent CAS, 693 (8.5%) were DDRF patients. After adjusting for age, gender, race, presence of dyslipidemia, congestive heart failure, and hypertension CAS performed in DDRF patients was associated with higher rates of in-hospital mortality(OR 3.7, 95% CI 1.0 - 13.9)(p=0.04) and moderate to severe disability (OR 1.7 , 95% CI 1.0 - 3.3)(p=0.05). Of the 43875 patients who underwent CEA, 3888 (8.8%) were DDRF patients. After adjusting for age, gender, race , presence of hypertension, congestive heart failure, dyslipidemia, nicotine dependence and alcohol abuse, CEA performed in DDRF patients was associated with higher rates of in-hospital mortality(OR 4.3, 95% CI 2.1 - 9.0)(p=<.0001) and moderate to severe disability (OR 1.4 , 95% CI 1.1 - 1.8)(p=0.009).
 
 
 Conclusions:
 Both CAS and CEA were associated with higher rates of in-hospital mortality and moderate to severe disability in DDRF patients.
