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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Contrast-induced nephropathy in patients with chronic kidney disease and peripheral arterial disease
Christian Kroneberger1, Christian N Enzweiler2, Andre Schmidt-Lucke3
1Charité - Universitätsmedizin Berlin, Berlin, Germany.
Insights
Patients with peripheral arterial disease and mild kidney impairment (eGFR 45-60) show no risk of contrast-induced nephropathy (CIN). However, those with severe impairment (eGFR <45) have a 10.9% risk of CIN after contrast material administration.
Area of Science:
- Nephrology
- Radiology
- Cardiovascular Medicine
Background:
- The risk of contrast-induced nephropathy (CIN) following intra-arterial contrast material application is not well-defined for patients with chronic kidney disease (CKD) and peripheral arterial disease (PAD).
- Understanding this risk is crucial for managing patients undergoing procedures requiring contrast agents.
Purpose of the Study:
- To determine the incidence of CIN in patients with CKD and PAD undergoing intra-arterial contrast material procedures.
- To identify potential risk factors associated with CIN in this patient population.
Main Methods:
- A retrospective study evaluated 120 patients with CKD and PAD undergoing 128 procedures.
- Patients received iodine-based low-osmolar contrast material after hydration with isotonic NaCl 0.9%.
- CIN was defined as a serum creatinine increase >44 μmol/L within 4 days; risk factors were analyzed.
Main Results:
- No CIN occurred in patients with an estimated glomerular filtration rate (eGFR) of 45-60 mL/min/1.73m² (0/73 procedures).
- CIN developed in 10.9% of procedures (6/55) in patients with eGFR <45 mL/min/1.73m².
- No specific risk factor significantly influenced CIN development, though baseline creatinine and eGFR showed trends.
Conclusions:
- Patients with PAD and an eGFR of 45-60 mL/min/1.73m² appear to have a low risk of CIN after intra-arterial contrast administration with adequate hydration.
- An eGFR <45 mL/min/1.73m² is associated with a 10.9% risk of CIN in this cohort.
Background:
The risk for contrast-induced nephropathy (CIN) after intra-arterial application of an iodine-based contrast material is unknown for patients with chronic kidney disease (CKD) and peripheral arterial disease (PAD).
Purpose:
To investigate the incidence of CIN in patients with CKD and PAD.
Material And Methods:
This retrospective study was approved by the local ethics committee. One hundred and twenty patients with 128 procedures (73 with baseline eGFR in the range of 45-60 mL/min/1.73m(2), 55 with eGFR < 45 mL/min/1.73m(2)) were evaluated. All patients received intra-arterially an iodine-based low-osmolar contrast material (CM) after adequate intravenous hydration with isotonic NaCl 0.9% solution. CIN was defined as an increase in serum creatinine of more than 44 μmol/L within 4 days. The influence of patient-related risk factors (age, weight, body mass index, eGFR, serum creatinine, hypertension, diabetes mellitus, coronary heart disease, heart failure) and therapy-related risk factors (amount of CM, nephrotoxic drugs, number of CM applications) on CIN were examined.
Results:
CIN developed in 0% (0/73) of procedures in patients with PAD and an eGFR in the range of 45-60 mL/min/1.73m(2) and in 10.9% (6/55) of procedures in patients with an eGFR <45 mL/min/1.73m(2). No risk factor significantly influenced the development of CIN, although baseline serum creatinine (P = 0.06) and baseline eGFR (P = 0.10) showed a considerable dependency.
Conclusion:
Patients with an eGFR in the range of 45-60 mL/min/1.73m(2) and PAD seem not at risk for CIN after intra-arterial CM application and adequate hydration. Whereas, an eGFR < 45 mL/min/1.73m(2) correlated with a risk of 10.9% for a CIN.
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