Acute Kidney Injury After Peripheral Interventions Using Carbon Dioxide Angiography-Risk Factors Beyond Iodinated...

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Interventional Radiology

Background:

• Contrast-associated acute kidney injury (CA-AKI) is a significant risk in endovascular procedures, particularly for patients with peripheral artery disease (PAD) and chronic kidney disease (CKD).
• Iodinated contrast media (ICM) are a common cause of CA-AKI.
• Carbon dioxide (CO2) offers a potential alternative contrast agent, especially for high-risk patients.

Purpose of the Study:

• To evaluate the incidence and risk factors of acute kidney injury (AKI) in patients with PAD and CKD undergoing peripheral angiography or intervention.
• To assess the safety and outcomes of using carbon dioxide (CO2) as the primary contrast medium in this high-risk population.

Main Methods:

• Retrospective study of 340 patients with PAD and CKD (stages 3-5) undergoing peripheral procedures between September 2014 and December 2020.
• Primary use of CO2 as the contrast medium, with optional bailout use of ICM (mean 21.23 ± 14.09 mL in 80% of cases).
• Analysis of post-interventional AKI incidence, severity, and independent risk factors using multivariate analysis.

Main Results:

• Post-interventional AKI occurred in 13.2% of patients, with over 70% classified as stage 1.
• Seven patients (2.1%) required new dialysis within 7 days.
• Independent AKI risk factors included hypertension, heart failure, and coronary artery disease; statin or RAAS inhibitor use and higher pre-interventional GFR were protective.

Conclusions:

• AKI remains a common complication in patients with PAD and advanced CKD undergoing CO2-guided peripheral procedures.
• While CO2 may reduce ICM exposure, AKI still occurs, highlighting the vulnerability of this patient group.
• Further research is necessary to elucidate the mechanisms of AKI in this context and optimize patient outcomes.