Contrast induced acute kidney injury in endovascular surgery

Endovascular interventions are associated with renal impairment possibly due to intraoperative contrast use. The goal of this study was to determine the incidence, risk factors and pharmacological prevention strategies for contrast-induced acute kidney injury in patients undergoing vascular surgery. Another aim was finding a threshold dose of contrast as a predictor of contrast-induced acute kidney injury.

Contrast-induced acute kidney injury was studied in patients submitted to vascular surgery procedures requiring intravascular contrast over a one year period (n=180). Clinical and outcome data were collected from medical records. Pearson chi-square test and Fisher's exact test were used for categorical variables. Student's t test was used for continuous variables.

The incidence of contrast-induced acute kidney injury was 10% [95%CI 6.42-15.25]. Contrast volumes over 175ml were associated with an 8-fold increase in the risk of contrast-induced acute kidney injury [95%CI 2.60-24.26; p<0.001]. The administration of N-acetylcysteine reduced the possibility of acute kidney injury occurrence in 28.20% [95%CI 9.50 - 83.50; p=0.022].

Patients that developed contrast-induced acute kidney injury were exposed to higher contrast volumes. This study suggests 175 ml of contrast volume as a cut-off value for the development of contrast-induced acute kidney injury. N-acetylcysteine had a protective effect in these patients submitted to endovascular surgery.