Preventing kidney injury using carbon dioxide (KID trial): trial protocol for a multicentre randomised controlled trial
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View abstract on PubMed
Summary
This summary is machine-generated.This study investigates if carbon dioxide (CO₂) imaging can prevent kidney injury in patients with peripheral arterial disease and chronic kidney disease undergoing endovascular procedures, compared to standard iodinated contrast.
Area Of Science
- Nephrology
- Vascular Surgery
- Radiology
Background
- Peripheral arterial disease (PAD) frequently co-occurs with chronic kidney disease (CKD).
- Endovascular revascularization is crucial for PAD patients but uses nephrotoxic iodinated contrast, risking acute kidney injury (AKI) in CKD patients.
- Automated carbon dioxide (CO₂) injection offers a potential alternative contrast agent to mitigate renal risks.
Purpose Of The Study
- To evaluate if CO₂ contrast reduces the risk of AKI and short-term renal function decline in patients with PAD and CKD undergoing endovascular intervention.
- To compare the incidence and severity of AKI, major adverse kidney events, and long-term renal function changes between CO₂ and iodinated contrast groups.
- To assess the feasibility, acceptability, and cost-effectiveness of using CO₂ as an alternative contrast medium.
Main Methods
- A multicentre, prospective, randomised controlled trial involving 174 patients with PAD and CKD.
- Patients were randomised 1:1 to receive either iodinated contrast (standard of care) or CO₂ via automated injector.
- Primary outcome: log serum creatinine at 2, 30, and 90 days post-procedure. Secondary outcomes include AKI incidence, major adverse kidney events, and quality of life.
Main Results
- The study is currently evaluating the primary outcome of log serum creatinine levels at 2, 30, and 90 days post-procedure.
- Key secondary outcomes, including AKI incidence and major adverse kidney events, are being assessed within 90 days.
- Feasibility, acceptability, and cost-effectiveness of CO₂ use are also under investigation through patient and practitioner questionnaires and healthcare resource use analysis.
Conclusions
- The findings will determine the safety and efficacy of CO₂ as a nephroprotective alternative to iodinated contrast in high-risk patients.
- This research aims to inform clinical practice guidelines for endovascular procedures in patients with comorbid PAD and CKD.
- Successful implementation of CO₂ angiography could significantly reduce contrast-induced nephropathy in vulnerable patient populations.
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