Renal dysfunction after angiography; a risk factor analysis in patients with peripheral vascular disease

Angiography is required for a detailed anatomical investigation before reconstructive surgery or percutaneous transluminal angioplasty can be performed. Although angiography is a safe procedure, it is associated with renal dysfunction, usually transient, in about 10% of the cases. This study concentrates on the evaluation of renal dysfunction induced by "conventional" (i.e. film-screen) Seldinger angiography and a consecutive series of 396 angiographic procedures have been evaluated. Induced Renal Dysfunction was defined as an increase of more than 10% in the serum creatinine after angiography. To identify "risk factors" for Induced Renal Dysfunction we have studied whether clinical and angiographical variables were associated with the occurrence of Induced Renal Dysfunction. These variables included: age, hypertension, the use of antihypertensive drugs, diabetes mellitus, technique of angiography, site of contrast injection and type and quantity of contrast medium. Induced Renal Dysfunction was found in 21 cases (5.7%) and appeared to be associated with age above 70, hypertension, administration of more than 150 ml contrast medium and the presence of renal disease prior to angiography. More than 95% of the 21 patients with dysfunction had two or more of these "risk factors". The presence of diabetes was not clearly associated with Induced Renal Dysfunction and haemodialyses was not required in any of the patients. The incidence of Induced Renal Dysfunction after angiography was 5.7% which is low but not negligible. However, renal dysfunction was always transient and never severe. Furthermore, the identification of "risk factors" allows the prompt identification of patients at risk before angiography, which may help to reduce the incidence of Induced Renal Dysfunction.