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Impact of Chronic Kidney Disease on Contrast-Induced Nephropathy, Bleeding, and Clinical Outcomes After Rotational

Jaeyun Lee1, Jin Jung2,3, Sang-Suk Choi2,3

  • 1Department of Nephrology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea.

Medicina (Kaunas, Lithuania)
|March 28, 2026
PubMed

Insights

Patients with chronic kidney disease (CKD) face higher risks of contrast-induced nephropathy (CIN) after rotational atherectomy (RA). However, RA is a feasible strategy for CKD patients when complications are managed, showing comparable long-term efficacy.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology
  • Renal Medicine

Background:

  • Chronic kidney disease (CKD) is linked to severe coronary calcification and increased procedural risks.
  • Patients with CKD undergoing interventions for coronary artery disease require careful risk assessment.

Purpose of the Study:

  • To evaluate the impact of CKD on contrast-induced nephropathy (CIN), bleeding, and clinical outcomes in patients undergoing rotational atherectomy (RA).
  • To identify CKD as a risk factor for adverse events post-RA.

Main Methods:

  • Retrospective analysis of 652 patients undergoing RA for calcified coronary lesions (2010-2025).
  • Patients were stratified into CKD (eGFR < 60 mL/min/1.73 m²; n=66) and non-CKD (n=586) groups.
  • Primary endpoint: composite of CIN and in-hospital bleeding. Secondary endpoints: 3-year target vessel failure (TVF), myocardial infarction (MI), and total bleeding.

Main Results:

  • The primary composite outcome (CIN and in-hospital bleeding) was significantly higher in the CKD group (16.7% vs. 5.1%, p=0.001).
  • Contrast-induced nephropathy (CIN) was markedly higher in CKD patients (15.2% vs. 1.7%, p<0.001); in-hospital bleeding showed no significant difference.
  • CKD independently predicted the primary outcome (adjusted OR 3.02; p=0.006). At 3-year follow-up, total bleeding and MI were higher in the CKD group.

Conclusions:

  • Chronic kidney disease (CKD) is a significant independent risk factor for contrast-induced nephropathy (CIN) and long-term bleeding after rotational atherectomy (RA).
  • Despite increased risks, rotational atherectomy (RA) demonstrates comparable clinical efficacy in CKD patients, provided early complications are managed with contrast-minimizing strategies.

Keywords:
chronic kidney disease (CKD)contrast-induced nephropathy (CIN)rotational atherectomy (RA)

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