Chronic Kidney Disease Requiring Hemodialysis as a Significant Predictor of Target Lesion Revascularization After Endovascular Treatment of Femoropopliteal Occlusive Lesions with a Drug-Coated Balloon

<b>Background:</b> Drug-coated balloons (DCBs) have been reported to have lowered the rate of restenosis and revascularization after endovascular treatment (EVT) of femoropopliteal (FP) lesions. Meanwhile, chronic kidney disease requiring hemodialysis (HD), which is becoming more prevalent in Japanese clinical settings, has been associated with poorer outcomes after EVT for FP lesions. This study aimed to retrospectively analyze the impact of HD on the outcomes of EVT using a DCB in a single center. <b>Methods</b>: This study included 161 consecutive FP lesions in 127 patients treated with a DCB between September 2018 and May 2023, stratified into HD (34.6%) and non-HD (65.4%) groups. The primary endpoint was clinically driven target lesion revascularization (CDTLR), and the secondary endpoints were major amputation and all-cause mortality. <b>Results</b>: The median observation period after EVT using a DCB was 336 days. Although a Rutherford's category of 4 or higher was significantly predominant in the HD group (82.3%) than the non-HD group (53.5%), a Rutherford's category of 4 or higher itself was not a statistically significant factor of the primary endpoint. The ratio of occluded lesion was significantly higher in the non-HD group (21.2%) than the HD group (8.1%). The duration of freedom from clinically driven target lesion revascularization (CDTLR) assessed via the Kaplan-Meier method was significantly shorter in the HD group (744 days) compared to the non-HD group (1533 days). The HD group had a higher incidence of CDTLR (odds ratio 4.48, <i>p</i> = 0.03) compared to the non-HD group. <b>Conclusions</b>: HD patients had significantly worse prognoses in EVT of FP lesions using a DCB.