Intra-arterial digital subtraction angiography (DSA) is commonly used for the diagnosis and treatment of patients with critical limb ischemia (CLI). The aim of this study was to analyze the incidence of contrast-induced nephropathy (CIN) in patients with CLI and to assess their outcomes. Between May 2013 and May 2014, a prospective and observational study was conducted with 107 patients admitted exclusively for CLI treatment. The main outcomes included hemodialysis independence (HI) and overall survival (OS), as assessed by Kaplan-Meier curves. Overall, there was a predominance of males (57%), with a mean age of 70.5 (10.7) years. The incidence of CIN was 35.5%, and chronic kidney failure was the only factor associated with elevated risk of this condition (relative risk [RR] = 1.9; 95% confidence interval = 1.17-3.09; P = .017). The median follow-up was 645 days, and in 720-day analyses, patients who experienced CIN had worse HI (81.2% vs 96.3%; P = .0107) and OS (49.5% vs 66.3%; P = .0463). The current study found a high incidence of CIN in patients with CLI after DSA. This renal impairment was associated with a worse prognosis in terms of survival.
KatzbergRWLambaR. Contrast-induced nephropathy after intravenous administration: fact or fiction?Radiol Clin North Am. 2009;47(5):789–800.
2.
McCulloughPAAdamABeckerCR.; CIN Consensus Working Panel. Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol. 2006;98(6A):5K–13K.
LevyEMViscoliCMHorwitzRI. The effect of acute renal failure on mortality. A cohort analysis. JAMA1996;275(19):1489–94.
5.
BradburyAWAdamDJBellJ; BASIL trial Participants. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg. 2010;51(suppl 5):5S–17S.
6.
GleesonTGBulugahapitiyaS. Contrast-induced nephropathy. AJR Am J Roentgenol. 2004;183(6):1673–89.
7.
RutherfordRBBakerJDErnstC. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517–38.
8.
NorgrenLHiattWRDormandyJA; TASC II Working Group. Intersociety consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(suppl S):S5–67.
9.
CramerBCParfreyPSHutchinsonTA. Renal function following infusion of radiologic contrast material. A prospective controlled study. Arch Intern Med. 1985;145(1):87–89
10.
CockcroftDWGaultMH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41.
11.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 suppl 1):S1–266.
12.
XuRTaoABaiYDengYChenG. Effectiveness of N-acetylcysteine for the prevention of contrast-induced nephropathy: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2016;5(9):1–15.
13.
BartholomewBAHarjaiKJDukkipatiS. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol. 2004;93(12):1515–9.
14.
MehranRAymongEDNikolskyE. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44(7):1393–9.
15.
R Core Team (2016). R: A Language And Environment For Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. URLhttps://www.R-project.org/.
16.
YancyCWJessupMBozkurtB. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):1810–52.
17.
WongPCLiZGuoJZhangA. Pathophysiology of contrast-induced nephropathy. Int J Cardiol. 2012;158(2):186–92.
18.
KarlsbergRPDohadSYShengRIodixanol PeripheralCTAStudy Investigator Panel. Contrast-induced acute kidney injury (CI-AKI) following intra-arterial administration of iodinated contrast media. J Nephrol. 2010;23(6):658–66.
19.
CigarroaRGLangeRAWilliamsRHHillisLD. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med. 1989;86(6 pt 1):649–52.
20.
BrownJRRobbJFBlockCA. Does safe dosing of iodinated contrast prevent contrast-induced acute kidney injury?Circ Cardiovasc Interv. 2010;3(4):346–50.
21.
ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized acetylcysteine for contrast-induced nephropathy trial (ACT). Circulation. 2011;124(11):1250–59.
22.
SigtermanTAKrasznaiAGSnoeijsMG. Contrast induced nephropathy and long-term renal decline after percutaneous transluminal angioplasty for symptomatic peripheral arterial disease. Eur J Vasc Endovasc Surg. 2016;51(3):386–93.
23.
MeloniMGiuratoLIzzoVStefaniniMGandiniRUccioliL. Risk of contrast induced nephropathy in diabetic patients affected by critical limb ischemia and diabetic foot ulcers treated by percutaneous transluminal angioplasty of lower limbs. Diabetes Metab Res Rev. 2017;33(3). doi:10.1002/dmrr.2866
24.
TsaiTTPatelUDChangTI. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv. 2014;7(1):1–9.
25.
GoldenbergIChoncholMGuettaV. Reversible acute kidney injury following contrast exposure and the risk of long-term mortality. Am J Nephrol. 2009;29(2):136–44.
26.
UzunhasanIYildizAArslanS. Contrast-induced acute kidney injury is associated with long-term adverse events in patients with acute coronary syndrome. Angiology. 2017;68(7):621–6.
27.
de Almeida MendesCde Arruda MartinsATeivelisMP. Carbon dioxide is a cost-effective contrast medium to guide revascularization of TASC A and TASC B femoropopliteal occlusive disease. Ann Vasc Surg. 2014;28(6):1473–8.
28.
SeegerJMSelfSHarwardTRFlynnTCHawkinsIFJr. Carbon dioxide gas as an arterial contrast agent. Ann Surg. 1993;217(6):688–98.
