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Lim DYZ, Goh JCH, He Y, Koniman R, Yap H, Ke Y, Sim YE, Abdullah HR. Contrast-Induced Acute Kidney Injury in Lower Limb Percutaneous Transluminal Angioplasty: A Machine Learning Approach for Preoperative Risk Prediction. Ann Vasc Surg 2025; 115:163-172. [PMID: 40081525 DOI: 10.1016/j.avsg.2025.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 01/11/2025] [Accepted: 01/25/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) is a common complication of lower limb percutaneous transluminal angioplasty (PTA). Common risk models are based on cardiology cohorts for percutaneous coronary intervention. They include a mix of preoperative and perioperative variables, but do not include important information such as inflammatory parameters and preoperative medications. None make use of machine learning. We aimed to develop an accurate preoperative risk model for CI-AKI in lower limb PTA using machine learning methods and comparing these with conventional logistic regression. MATERIALS AND METHODS A retrospective cohort of 456 patients who underwent lower limb PTA as an isolated procedure from 2015 to 2019 was identified. Patients <21 years old, patients with a preoperative estimated glomerular filtration rate of <15 mL/min/1.73 m2 as defined by the modification of diet in renal disease, and patients with no valid preoperative or postoperative serum creatinine were excluded. Conventional logistic regression and a range of machine learning models were fitted (logistic regression with elastic-net penalty, random forests, gradient boosting machines, k-nearest neighbors, Support vector machines, and multilayer perceptron), using 5-fold cross-validation and grid search for hyperparameter selection. Area under receiver operating curve, area under precision-recall curve, F1 score, and the sensitivity and specificity were determined on the test set. Variable importance was examined using SHapley Additive exPlanation plots. RESULTS Machine learning models performed well, with the best performance by the k-nearest neighbors algorithm (area under receiver operating curve = 0.914, area under precision-recall curve = 0.809). Important variables identified by SHapley Additive exPlanation plot analysis included modification of diet in renal disease estimated glomerular filtration rate, haemoglobin, and inflammatory indices (neutrophil: lymphocyte ratio, red cell distribution width). CONCLUSION We developed machine learning models to accurately predict CI-AKI in patients undergoing elective lower limb PTA, using preoperative variables only. This model may be used for preoperative patient risk counseling by surgeons and anesthetists and may assist in identifying high-risk patients for further monitoring.
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Affiliation(s)
- Daniel Y Z Lim
- Health Service Research Unit, Medical Board, Singapore General Hospital, Singapore
| | - Jason C H Goh
- Department of Anaesthesiology, Singapore General Hospital, Singapore.
| | - Yingke He
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Riece Koniman
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Haoyun Yap
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Yuhe Ke
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Yilin Eileen Sim
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Hairil Rizal Abdullah
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
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Katsogridakis E, Saha P, Diamantopoulos A, Saratzis N, Davies R, Zayed H, Bown MJ, Saratzis A. Long-Term Effects of Acute Kidney Injury Following Endovascular Femoropopliteal Intervention: Insights From a Multicenter Trial. J Endovasc Ther 2024; 31:634-642. [PMID: 36415924 DOI: 10.1177/15266028221136436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To examine the association between acute kidney injury (AKI) severity and duration with cardiovascular mortality, following endovascular treatment of femoropopliteal disease, and whether it is AKI in itself that confers an increased risk of cardiovascular mortality. METHODS A retrospective analysis of prospectively collected data obtained between 2014 and 2019 from 3 vascular centers. Renal function was followed up for a minimum of 90 days. Electronic records were queried to establish a cause of death, where applicable. Patients were excluded if unable to provide written informed consent or if presenting with acute limb ischemia. Primary outcomes were the hazard ratios for cardiovascular death (AKI patients vs no AKI; no AKI vs stage 1 AKI vs stage 3 AKI; and no AKI vs transient AKI vs established AKI). Propensity score-matched analysis was used to establish whether developing AKI, in patients with similar demographics and procedural characteristics, is associated with a higher risk of cardiovascular death. RESULTS Overall 239 patients developed AKI, and this was associated with an increased risk of cardiovascular mortality (hazard risk [HR]: 4.3, 95% confidence intervals [CIs]: 2.1-6.8, pairwise comparison p value=0.006]. This was dependent on the severity of the AKI stage (HR 5.4, 95% CI: 2.4-7.3, pairwise comparison p value=0.01) and duration (HR 4.2, 95% CI: 2.3-6.2, pairwise comparison p value=0.04). The propensity score-matched analysis showed that even when patients are matched for comorbidity and procedural characteristics, AKI confers an increased risk of mortality (p=0.04). CONCLUSIONS Acute kidney injury is common after femoropopliteal endovascular therapy. It confers an increased risk of long-term cardiovascular mortality, which is still present when renal decline is transient, and highest for patients with established decline in renal function. CLINICAL IMPACT This is the first study in the setting of peripheral arterial disease to show that acute kidney injury has an adverse effect on cardiovascular mortality, in the long-term, that is dependent on its severity, and present even when the AKI is transient. We have also shown that this difference in cardiovascular mortality becomes more pronounced from the medium-term, and thus closer follow-up of these patients is required.
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Affiliation(s)
- Emmanuel Katsogridakis
- Leicester Vascular Institute, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Prakash Saha
- Department of Vascular Surgery, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | | | - Nikolaos Saratzis
- Department of Vascular Surgery, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Robert Davies
- Leicester Vascular Institute, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Matthew J Bown
- Leicester Vascular Institute, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Athanasios Saratzis
- Leicester Vascular Institute, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Lee SR, Ali S, Cardella J, Turner J, Guzman RJ, Dardik A, Ochoa Chaar CI. Carbon dioxide angiography during peripheral vascular interventions is associated with decreased cardiac and renal complications in patients with chronic kidney disease. J Vasc Surg 2023; 78:201-208. [PMID: 36948278 DOI: 10.1016/j.jvs.2023.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Patients with chronic kidney disease (CKD) who undergo peripheral vascular interventions (PVI) with iodinated contrast are at higher risk of post-contrast acute kidney injury (PC-AKI). Carbon dioxide (CO2) angiography can reduce iodinated contrast volume usage in this patient population, but its impact on PC-AKI has not been studied. We hypothesize that CO2 angiography is associated with a decrease in PC-AKI in patients with advanced CKD. METHODS The Vascular Quality Initiative PVI dataset from 2010 to 2021 was reviewed. Only patients with advanced CKD (estimated glomular filtration rate <45 ml/min/1.73 m2) treated for peripheral arterial disease were included. Propensity matching and multivariate logistic regression based on demographics, comorbidities, CKD stage, and indications were used to compare the outcomes of patients treated with and without CO2. RESULTS There were 20,706 PVIs performed in patients with advanced CKD, and only 22% utilized CO2 angiography. Compared with patients treated without CO2, patients who underwent CO2 angiography were younger and less likely to be women or White, and more likely to have poor renal function, diabetes, cardiac comorbidities, and present with tissue loss. Propensity matching yielded well-matched groups with 4472 patients in each group. The procedural details after matching demonstrated 50% reduction in the volume of contrast used (32±33 vs 65±48 mL; P < .01). PVI with CO2 angiography was associated with lower rates of PC-AKI (3.9% vs 4.8%; P = .03) and cardiac complications (2.1% vs 2.9%; P = .03) without a significant difference in technical failure or major/minor amputations. Low contrast volumes (≤50 mL for CKD3, ≤20 mL for CKD4, and ≤9 mL for CKD5) are associated with reduced risk of PC-AKI (hazard ratio, 0.59; P < .01). CONCLUSIONS CO2 angiography reduces iodinated contrast volume usage during PVI and is associated with decreased cardiac complications and PC-AKI. CO2 angiography is underutilized and should be considered for patients with advanced CKD who require endovascular therapy.
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Affiliation(s)
- Shin-Rong Lee
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT.
| | - Sahar Ali
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Jonathan Cardella
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Jeffrey Turner
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
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Danışan G, Taydaş O, Özdemir M, Ateş ÖF, Küpeli A, Öğüşlü U, Erkin A, Neşelioğlu S, Eren F. Dynamic thiol-disulphide homeostasis as a biomarker for predicting the development of contrast medium-associated acute kidney injury in the endovascular treatment of peripheral arterial disease: should intravenous N-acetylcysteine be given before the procedure? Clin Radiol 2023; 78:466-472. [PMID: 36941180 DOI: 10.1016/j.crad.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
AIM To determine the predictive ability of serum thiol-disulphide levels for contrast medium-associated acute kidney injury (CA-AKI) after endovascular treatment (EVT) of peripheral arterial disease (PAD) and evaluate the efficacy of intravenous N-acetylcysteine (NAC) in preventing CA-AKI. MATERIAL AND METHODS This double-blind, randomised controlled study included 85 consecutive adult patients who underwent EVT for PAD. Patients were divided into NAC negative (NAC-) and positive (NAC+) groups. While the NAC- group received only 500 ml saline, the NAC + group received 500 ml saline plus intravenous 600 mg NAC before the procedure. Intra- and intergroup patient characteristics, procedural details, preoperative thiol-disulphide levels, and ischaemia-modified albumin (IMA) levels were recorded. RESULTS There was a significant difference between NAC- and NAC + groups regarding native thiol, total thiol, disulphide/native thiol ratio (D/NT), and disulphide/total thiol ratio (D/TT). There was also a significant difference between the NAC- (33.3%) and NAC+ (13%) groups in CA-AKI development. Logistic regression analysis showed that the D/TT (OR 2.463) and D/NT (OR 2.121) were the most influential parameters for CA-AKI development. In the receiver operating characteristic (ROC) curve analysis, the sensitivity of native thiol to detect the development of CA-AKI was 89.1%. The negative predictive values of native thiol and total thiol were 95.6% and 94.1%, respectively. CONCLUSION The serum thiol-disulphide level can be used as a biomarker to detect CA-AKI development and reveal patients with a low risk for CA-AKI development before EVT of PAD. Furthermore, thiol-disulphide levels allow for the indirect quantitative monitoring of NAC. Preprocedural intravenous NAC administration significantly inhibits CA-AKI development.
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Affiliation(s)
- G Danışan
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey.
| | - O Taydaş
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey
| | - M Özdemir
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey
| | - Ö F Ateş
- Sakarya University Faculty of Medicine, Department of Radiology, Sakarya, Turkey
| | - A Küpeli
- Kanuni Training and Research Hospital, Department of Radiology, Trabzon, Turkey
| | - U Öğüşlü
- Medicana International Hospital, Department of Radiology, Istanbul, Turkey
| | - A Erkin
- Sakarya University Faculty of Medicine, Department of Cardiovascular Surgery, Sakarya, Turkey
| | - S Neşelioğlu
- Ankara City Hospital, Department of Biochemistry, Ankara, Turkey
| | - F Eren
- Ankara City Hospital, Department of Biochemistry, Ankara, Turkey
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The Role of RIPC in Preventing Organ Damage, Inflammation, and Oxidative Stress during Lower Limb DSA: A Randomised Controlled Trial. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6043550. [PMID: 34925697 PMCID: PMC8674049 DOI: 10.1155/2021/6043550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
Objective Diagnostic digital subtraction angiography (DSA) and DSA with percutaneous transluminal angioplasty (DSA-PTA) are common procedures for diagnosing and treating symptomatic lower extremity arterial disease (LEAD). However, organ damage following DSA and DSA-PTA is often underrecognised and hence undiagnosed. To reduce the risk induced by invasive procedures in symptomatic LEAD patients, the method of remote ischemic preconditioning (RIPC) has been suggested. The aim of the current study was to assess the effect of RIPC intervention on the organ damage markers profile, oxidative stress, and inflammation biomarkers in LEAD patients undergoing DSA and DSA-PTA procedure. Methods The RIPC intervention was performed by inflating a standard blood pressure cuff on the patient's upper arm to 200 mmHg for 5 minutes four times with 5-minute perfusion between each cycle. The sham intervention was performed similarly, but the cuff was inflated to 20 mmHg. Changes in the cardiac and renal damage biomarkers' profile, oxidative stress, and inflammation biomarkers were recorded before and 24 hours after DSA or DSA-PTA. Results A total of 111 (RIPC 54, sham 57) patients with symptomatic LEAD scheduled for endovascular procedure were randomised, and 102 patients (RIPC 47, sham 55) completed the study protocol. RIPC significantly limited the increase of adiponectine levels after DSA and DSA-PTA, compared to sham intervention (p = 0.020), but CK-MB levels were markedly lower in the sham group (p = 0.047) after procedure. There was no significant difference between the RIPC and the sham group in mean changes in hs-troponin-T (p = 0.25), NT-proBNP (p = 0.24), creatinine (p = 0.76), eGFR (p = 0.61), urea (p = 0.95), beta-2-microglobuline (p = 0.34), or cystatine C (p = 0.24) levels. Conclusion In this controlled clinical study, RIPC failed to improve the profile of renal and cardiac biomarkers in patients with LEAD periprocedurally. RIPC significantly limits the rise in adiponectin levels and may influence the decrease of CK-MB levels 24 hours after endovascular procedure.
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Safley DM, Salisbury AC, Tsai TT, Secemsky EA, Kennedy KF, Rogers RK, Latif F, Shammas NW, Garcia L, Cavender MA, Rosenfield K, Prasad A, Spertus JA. Acute Kidney Injury Following In-Patient Lower Extremity Vascular Intervention: From the National Cardiovascular Data Registry. JACC Cardiovasc Interv 2021; 14:333-341. [PMID: 33541543 DOI: 10.1016/j.jcin.2020.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The authors analyzed data from the NCDR (National Cardiovascular Data Registry) PVI Registry and defined acute kidney injury (AKI) as increased creatinine of ≥0.3 mg/dl or 50%, or a new requirement for dialysis after PVI. BACKGROUND AKI is an important and potentially modifiable complication of peripheral vascular intervention (PVI). The incidence, predictors, and outcomes of AKI after PVI are incompletely characterized. METHODS A hierarchical logistic regression risk model using pre-procedural characteristics associated with AKI was developed, followed by bootstrap validation. The model was validated with data submitted after model creation. An integer scoring system was developed to predict AKI after PVI. RESULTS Among 10,006 procedures, the average age of patients was 69 years, 58% were male, and 52% had diabetes. AKI occurred in 737 (7.4%) and was associated with increased in-hospital mortality (7.1% vs. 0.7%). Reduced glomerular filtration rate, hypertension, diabetes, prior heart failure, critical or acute limb ischemia, and pre-procedural hemoglobin were independently associated with AKI. The model to predict AKI showed good discrimination (optimism corrected c-statistic = 0.68) and calibration (corrected slope = 0.97, intercept of -0.07). The integer point system could be incorporated into a useful clinical tool because it discriminates risk for AKI with scores ≤4 and ≥12 corresponding to the lower and upper 20% of risk, respectively. CONCLUSIONS AKI is not rare after PVI and is associated with in-hospital mortality. The NCDR PVI AKI risk model, including the integer scoring system, may prospectively estimate AKI risk and aid in deployment of strategies designed to reduce risk of AKI after PVI.
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Affiliation(s)
- David M Safley
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA.
| | - Adam C Salisbury
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Thomas T Tsai
- Interventional Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Eric A Secemsky
- Vascular Intervention, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin F Kennedy
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - R Kevin Rogers
- Vascular Medicine & Intervention, University of Colorado, Aurora, Colorado, USA
| | - Faisal Latif
- Interventional Cardiology, University of Oklahoma & VA Medical Center, Oklahoma City, Oklahoma, USA
| | | | - Lawrence Garcia
- Section of Interventional Cardiology, Tufts University School of Med, Boston, Massachusetts, USA
| | - Matthew A Cavender
- Interventional Cardiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kenneth Rosenfield
- Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anand Prasad
- Cardiovascular Disease, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - John A Spertus
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Hechanova LA, Mukherjee D. Contrast-induced Nephropathy in Extra-cardiac Vascular Procedures - A Call to Action. Curr Vasc Pharmacol 2021; 20:27-28. [PMID: 34254922 DOI: 10.2174/1570161119666210712122757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Lisa Aimee Hechanova
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, United States
| | - Debabrata Mukherjee
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, United States
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Raffort J, Lareyre F, Katsiki N, Mikhailidis DP. Contrast-induced nephropathy in non-cardiac vascular procedures, a narrative review: Part 2. Curr Vasc Pharmacol 2021; 20:16-26. [PMID: 34238195 DOI: 10.2174/1570161119666210708165748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
This is Part 2 of a narrative review summarizing the literature on CIN after non-cardiac vascular diagnostic or therapeutic procedures, focusing on peripheral artery disease (PAD) and renal artery stenosis (RAS). Part 1 discussed CIN in relation to aortic aneurysms and carotid stenosis. We comment on the incidence, biomarkers, risk factors, and consequences of CIN in patients with PAD or RAS, as well as on strategies to prevent CIN. Future perspectives in the field of CIN in relation to non-cardiac vascular procedures are also considered.
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Affiliation(s)
- Juliette Raffort
- Clinical Chemistry Laboratory, University Hospital of Nice. France
| | - Fabien Lareyre
- Université Côte d'Azur, CHU, Inserm U1065, C3M, Nice. France
| | - Niki Katsiki
- First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, AHEPA University Hospital, 1st Stilponos Kyriakidi, 546 21, Thessaloniki, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom
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R A, Am K, Ah M, Ck B, S R, M F. Interventional revascularization prior to operative fixation of fractures below the knee. A retrospective case series. Injury 2021; 52:1939-1943. [PMID: 34020779 DOI: 10.1016/j.injury.2021.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 02/02/2023]
Abstract
AIMS The goal of the current study was to describe the results of an innovative standardized approach to prevent wound complications in patients with PAD sustaining fractures below the knee. PATIENTS AND METHODS In this retrospective case series, patients submitted to our institution with fractures below the knee, which were treated with endovascular recanalization of relevant stenosis or occlusions prior to definitive open reduction and fracture fixation between January 2015 and December 2019 were included. RESULTS Overall 23 patients (mean age 77 ± 9.8 years) were included in the current case series. In five patients (21.7 %) PAD was previously diagnosed. Endovascular interventions were performed 6.9 ± 2.5 days after fracture event and 2.5 ± 1.3 days prior to definitive surgical fixation of the lower limb fracture. After intervention 2 patients had one vessel, 10 patients two vessels and 11 patients three vessels for arterial perfusion of the lower limb. No interventional- radiology procedure related complications were observed. In this case series only two wound infections (8.7 %) occurred. CONCLUSION Endovascular intervention prior to surgical fixation resulted in a low complication rate after surgical fixation of fractures below the knee in patients with PAD. These results emphasize the crucial role of limb perfusion for adequate wound healing in lower limb fractures. Therefore, examination of limb perfusion should be an integral part of preoperative preparation of patients at high risk for PAD presenting with fractures below the knee. Endovascular recanalization seems to be an appropriate method to prevent wound complications.
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Affiliation(s)
- Aigner R
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Marburg, Germany
| | - König Am
- Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, Marburg, Germany
| | - Mahnken Ah
- Philipps-University of Marburg, Clinic of Diagnostic and Interventional Radiology, Marburg, Germany
| | - Boese Ck
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ruchholtz S
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Marburg, Germany
| | - Frink M
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Marburg, Germany.
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Katsogridakis E, Lea T, Yap T, Batchelder A, Saha P, Diamantopoulos A, Saratzis N, Davies R, Zayed H, Bown MJ, Saratzis A. Acute kidney injury following endovascular intervention for peripheral artery disease. Br J Surg 2021; 108:152-159. [PMID: 33711140 DOI: 10.1093/bjs/znaa057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/21/2020] [Accepted: 09/27/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The incidence of, and risk factors for, acute kidney injury (AKI) after endovascular intervention for peripheral artery disease (PAD) remain unknown. The aim of this study was to assess the proportion of patients who develop AKI and explore the risk factors. METHODS Prospectively collected data on patients undergoing femoropopliteal endovascular intervention for symptomatic PAD across three vascular centres were analysed. The proportion of patients developing AKI (according to the Kidney Disease Improving Global Outcomes definition) within 48 h, and the proportion developing the composite Major Adverse Kidney Events (MAKE) endpoints (death, dialysis, drop in estimated glomerular filtration rate at least 25 per cent) at 30 days (MAKE30) and remains 90 days (MAKE90) were calculated. Multivariable regression analysis was used to assess predictors of AKI, and the association between AKI and death. RESULTS Some 2041 patients were included in the analysis. AKI developed in 239 patients (11.7 per cent), with 47 (2.3 per cent) requiring dialysis within 30 days, and 18 (0.9 per cent) requiring ongoing dialysis. The MAKE30 and MAKE90 composite endpoints were reached in 358 (17.5 per cent) and 449 (22.0 per cent) patients respectively. Risk factors for AKI were age, sex, congestive heart failure, chronic limb-threatening ischaemia, emergency procedure, and pre-existing chronic kidney disease. AKI, dementia, congestive heart failure, and major amputation were risk factors for medium-term mortality. CONCLUSION AKI is a common complication after intervention for PAD and is associated with medium-term mortality.
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Affiliation(s)
- E Katsogridakis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - T Lea
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - T Yap
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Batchelder
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - P Saha
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Diamantopoulos
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - N Saratzis
- Department of Vascular Surgery, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - R Davies
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - H Zayed
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - M J Bown
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - A Saratzis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.,Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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RenalGuard system and conventional hydration for preventing contrast-associated acute kidney injury in patients undergoing cardiac interventional procedures: A systematic review and meta-analysis. Int J Cardiol 2021; 333:83-89. [PMID: 33662483 DOI: 10.1016/j.ijcard.2021.02.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/29/2020] [Accepted: 02/24/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Contrast-associated acute kidney injury (CA-AKI) can increase the mortality of patients undergoing transcatheter aortic valve replacement (TAVR) or percutaneous coronary intervention (PCI). The purpose of this paper was to compare the efficacy of the RenalGuard System and conventional hydration regimen in preventing CA-AKI in patients with TAVR or PCI. METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Clinical Trials (last updated July 11, 2020) for suitable reports. The primary outcome was the occurrence of CA-AKI. The secondary outcomes were renal replacement therapy (RRT), major cardiovascular events (MACEs), and other adverse complications. RESULTS The search strategy yielded 270 studies (with data for 2067 participants). In the subgroup of PCI, low incidence of CA-AKI (6.7% vs 15.7%; 95%CI: 0.27 to 0.54; I2 = 8%; P < 0.00001) associate with RenalGuard group (RG) rather than control group (CG). Similarly, in the subgroup of TAVR, a low incidence of CA-AKI (15.6% vs 26.9%; 95%CI: 0.35 to 0.82; I2 = 88%; P = 0.004) relates to RG. However, this result is highly heterogeneous. Compare with conventional hydration, RenalGuard significantly reduce the incidence of pulmonary edema (1.5%vs4.1%; 95%CI: 0.18 to 0.72; I2 = 0%; P = 0.004). CONCLUSIONS RenalGuard System can lessen the risk of CA-AKI and RRT in patients undergoing PCI. But for patients experiencing TAVR, due to unique hemodynamic effects, the role of RenalGuard remains questionable. RenalGuard is more secure than conventional hydration. Future work should elucidate the feasibility and safety of this prophylactic intervention in cardiac interventional therapy.
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Lee SR, Dardik A, Chaar CIO. Strategies to Minimize Iodinated Contrast Volume in Patients with Chronic Kidney Disease Undergoing Peripheral Vascular Interventions. Ann Vasc Surg 2021; 73:490-495. [PMID: 33556507 DOI: 10.1016/j.avsg.2021.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022]
Abstract
Peripheral vascular interventions (PVI) utilize iodinated contrast medium (ICM) to visualize intravascular lesions and guide therapy. The use of ICM carries a risk of postcontrast acute kidney injury (PC-AKI), which is increased in the elderly and in patients with chronic kidney disease (CKD). Furthermore, the risk of PC-AKI increases with the volume of ICM used. This paper reports a 94-year-old patient with CKD stage 4 who presented with chronic limb threatening ischemia. He underwent successful endovascular revascularization using a combination of CO2 and dilute ICM (total volume = 6.5 mL). The case demonstrates strategies to minimize ICM during PVIs.
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Affiliation(s)
- Shin-Rong Lee
- Department of Surgery, Yale School of Medicine, New Haven, CT.
| | - Alan Dardik
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
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Hudgi VV, Nishan B, Sivakrishna K, Kiran IS, Rodney R, Motukuru V. Contrast-induced nephropathy following peripheral endovascular intervention and its long-term morbidity. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_148_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Valentine EA, Gold AK, Ochroch EA. The Year in Vascular Anesthesia: Selected Highlights From 2019. J Cardiothorac Vasc Anesth 2020; 34:2906-2912. [PMID: 32826135 DOI: 10.1053/j.jvca.2020.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth A Valentine
- Department of Anesthesiology and Critical Care, Division of Cardiovascular and Thoracic Anesthesiology, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Andrew K Gold
- Department of Anesthesiology and Critical Care, Division of Cardiovascular and Thoracic Anesthesiology, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - E Andrew Ochroch
- Department of Anesthesiology and Critical Care, Division of Cardiovascular and Thoracic Anesthesiology, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
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15
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Lee SR, Dardik A, Ochoa Chaar CI. Postcontrast Acute Kidney Injury after Peripheral Vascular Interventions in Kidney Transplant Recipients. Ann Vasc Surg 2020; 68:8-14. [PMID: 32428641 DOI: 10.1016/j.avsg.2020.04.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postcontrast acute kidney injury (PC-AKI) is a feared complication of peripheral vascular interventions (PVIs), associated with increased mortality. Whether kidney transplant recipients (KTRs) are at increased risk of PC-AKI after PVI is unknown. This study analyzes the perioperative outcomes of KTR following PVI, with emphasis on the incidence and risk factors for PC-AKI. METHODS The Vascular Quality Initiative files for PVI (2010-2018) were reviewed. Patients on dialysis were excluded. PC-AKI was defined by Vascular Quality Initiative as creatinine increase ≥0.5 mg/dL or new dialysis requirement. Characteristics of KTR and patients without kidney transplant were compared, and propensity score matching used to control for differences in baseline features. Multivariable logistic regression was used to define risk factors for PC-AKI, and survival was compared using Kaplan-Meier analysis. RESULTS A total of 58,014 procedures were analyzed, including 641 (1%) procedures for KTR. The incidence of PC-AKI in KTR was 2.8% compared with 0.9% in patients without kidney transplants. Baseline warfarin use (odds ratio [OR] = 4.7) and poor allograft function (OR = 4.0) were significantly associated with increased risk for PC-AKI in KTR. Compared with a matched group of patients without kidney transplant, KTR had similar risk of PC-AKI and were more likely to develop postop myocardial infarction (OR = 4.3) but had lower in-hospital mortality (OR = 0.22). CONCLUSIONS The incidence of PC-AKI in KTR is higher than the overall population undergoing PVI but is not elevated compared with propensity-matched patients without kidney transplant. PVI for peripheral artery disease in KTR is safe and associated with acceptable perioperative and long-term survival.
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Affiliation(s)
- Shin-Rong Lee
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery, Yale University School of Medicine, New Haven, CT
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Gupta A, Dosekun AK, Kumar V. Carbon dioxide-angiography for patients with peripheral arterial disease at risk of contrast-induced nephropathy. World J Cardiol 2020; 12:76-90. [PMID: 32184976 PMCID: PMC7061263 DOI: 10.4330/wjc.v12.i2.76] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/03/2020] [Accepted: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
Patients with peripheral arterial disease (PAD) and critical limb ischemia are at risk for limb amputation and require urgent management to restore blood flow. Patients with PAD often have several comorbidities, including chronic kidney disease, diabetes mellitus, and hypertension. Diagnostic and interventional angiography using iodinated contrast agents provides excellent image resolution but can be associated with contrast-induced nephropathy (CIN). The use of carbon dioxide (CO2) as a contrast agent reduces the volume of iodine contrast required for angiography and reduces the incidence of CIN. However, CO2 angiography has been underutilized due to concerns regarding safety and image quality. Modern CO2 delivery systems with advanced digital subtraction angiography techniques and hybrid angiography have improved imaging accuracy and reduced the incidence of CIN. Awareness of the need for optimal imaging conditions, contraindications, and potential complications have improved the safety of CO2 angiography. This review aims to highlight current technological advances in the delivery of CO2 in vascular angiography for patients with PAD and critical limb ischemia, which result in limb preservation while preventing kidney damage.
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Affiliation(s)
- Amol Gupta
- Department of Cardiology, Heart, Vascular and Leg Center, Bakersfield, CA 93309, United States
| | | | - Vinod Kumar
- Department of Cardiology, Heart, Vascular and Leg Center, Bakersfield, CA 93309, United States
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Lee SR, Zhuo H, Zhang Y, Dahl N, Dardik A, Ochoa Chaar CI. Risk factors and safe contrast volume thresholds for postcontrast acute kidney injury after peripheral vascular interventions. J Vasc Surg 2019; 72:603-610.e1. [PMID: 31843298 DOI: 10.1016/j.jvs.2019.09.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/24/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Postcontrast acute kidney injury (PC-AKI) is a dreaded complication of peripheral vascular interventions (PVIs) that depends on the volume of contrast administered as well as a patient's baseline kidney function. However, there is currently no guidance on the volume of contrast that is considered safe especially for patients with advanced chronic kidney disease (CKD). This study aims to characterize the incidence, risk factors for, and outcomes after PC-AKI and define thresholds of safety for contrast volume. METHODS The Vascular Quality Initiative files for PVI (2010-2018) were reviewed. Patients on dialysis, with renal transplants, or who developed a bleeding complication were excluded. Only records with complete data on baseline creatinine, contrast volume, and PC-AKI (creatinine increase of ≥0.5 mg/dL, or new dialysis requirement) were included. The cumulative incidence of PC-AKI with contrast volume at each stage of CKD was derived. A safe threshold for contrast volume was defined as the volume at which the cumulative incidence of PC-AKI is 0.5% or less. Multivariable logistic regression was used to define risk factors for PC-AKI, and survival analysis was performed using Kaplan-Meier and multivariable Cox proportional hazards regression. RESULTS A total of 53,780 procedures were included. There were 16,062 patients (29%) with normal kidney function or CKD1, 21,769 (39%) with CKD2, 14,234 (25%) with CKD3, 1471 (3%) with CKD4, and 199 (<1%) with CKD5. The incidence of PC-AKI was 0.9% and increased with each stage of CKD (CKD1, 0.39%; CKD2, 0.45%; CKD3, 1.5%; CKD4, 4.3%; and CKD5, 7.5%). The safe thresholds for contrast volume for advanced CKD were 50, 20, and 9 mL for CKD3, CKD4, and CKD5, respectively. Regression analysis demonstrated that white race (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.54-0.82) and elective surgery (OR, 0.77; 95% CI, 0.62-0.95) were associated with decreased risk of PC-AKI, whereas inpatient status (OR, 14.5; 95% CI, 9.97-21.2), diabetes (OR, 1.27; 95% CI, 1.02-1.58), advanced CKD (CKD3: OR, 3.65; 95% CI, 2.68-4.98; CKD4: OR, 6.98; 95% CI, 4.72-10.3; CKD5: OR, 8.94; 95% CI, 4.53-17.6), critical limb ischemia (OR, 1.51; 95% CI, 1.14-2.00), acute limb ischemia (OR, 2.47; 95% CI, 1.70-3.59), and contrast-to-eGFR ratio (CGR) (2 ≤ CGR < 3: OR, 1.33; 95% CI, 1.02-1.74; 3 ≤ CGR < 4: OR, 1.90; 95% CI, 1.32-2.75; CGR ≥ 4: OR, 1.79; 95% CI, 1.18-2.70) were significantly associated with increased risk for PC-AKI. Patients who developed PC-AKI had worse in-hospital (16.1% vs 0.45%; P < .01) mortality and long-term survival (log-rank P < .01) compared with those without PC-AKI. CONCLUSIONS PVI are associated with low risk of PC-AKI that significantly increases when patients with advanced CKD undergo high acuity cases. Given the strong association with short-term and long-term mortality, risk of PC-AKI should be minimized by using safe thresholds of contrast volume.
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Affiliation(s)
- Shin-Rong Lee
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Haoran Zhuo
- Surgical Outcomes and Epidemiology, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Yawei Zhang
- Surgical Outcomes and Epidemiology, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Neera Dahl
- Nephrology Section, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Alan Dardik
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
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Zhang P, Li WY, Yang SC, Fu NK, Liu XG, Zhang X, Cong HL, Lin WH, Tian FS, Lu CZ, Zhang J. Preventive Effects of Nicorandil and Contrast-Induced Nephropathy. Angiology 2019; 71:190. [PMID: 31711308 DOI: 10.1177/0003319719887557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Peng Zhang
- Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | | | - Shi-Cheng Yang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Nai-Kuan Fu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xiao-Gang Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xue Zhang
- Tianjin Medical University, Tianjin, China
| | - Hong-Liang Cong
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wen-Hua Lin
- Department of Cardiology, Taida International Cardiovascular Hospital, Tianjin, China
| | - Feng-Shi Tian
- Department of Cardiology, Tianjin Fourth Central Hospital, Tianjin, China
| | - Cheng-Zhi Lu
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
| | - Jing Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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Berru FN, Gray SE, Thome T, Kumar RA, Salyers ZR, Coleman M, Dennis Le, O'Malley K, Ferreira LF, Berceli SA, Scali ST, Ryan TE. Chronic kidney disease exacerbates ischemic limb myopathy in mice via altered mitochondrial energetics. Sci Rep 2019; 9:15547. [PMID: 31664123 PMCID: PMC6820860 DOI: 10.1038/s41598-019-52107-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/12/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) substantially increases the severity of peripheral arterial disease (PAD) symptomology, however, the biological mechanisms remain unclear. The objective herein was to determine the impact of CKD on PAD pathology in mice. C57BL6/J mice were subjected to a diet-induced model of CKD by delivery of adenine for six weeks. CKD was confirmed by measurements of glomerular filtration rate, blood urea nitrogen, and kidney histopathology. Mice with CKD displayed lower muscle force production and greater ischemic lesions in the tibialis anterior muscle (78.1 ± 14.5% vs. 2.5 ± 0.5% in control mice, P < 0.0001, N = 5-10/group) and decreased myofiber size (1661 ± 134 μm2 vs. 2221 ± 100 μm2 in control mice, P < 0.01, N = 5-10/group). This skeletal myopathy occurred despite normal capillary density (516 ± 59 vs. 466 ± 45 capillaries/20x field of view) and limb perfusion. CKD mice displayed a ~50-65% reduction in muscle mitochondrial respiratory capacity in ischemic muscle, whereas control mice had normal mitochondrial function. Hydrogen peroxide emission was modestly higher in the ischemic muscle of CKD mice, which coincided with decreased oxidant buffering. Exposure of cultured myotubes to CKD serum resulted in myotube atrophy and elevated oxidative stress, which were attenuated by mitochondrial-targeted therapies. Taken together, these findings suggest that mitochondrial impairments caused by CKD contribute to the exacerbation of ischemic pathology.
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Affiliation(s)
- Fabian N Berru
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Sarah E Gray
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, FL, USA
| | - Trace Thome
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Ravi A Kumar
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Zachary R Salyers
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Madeline Coleman
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Dennis Le
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Kerri O'Malley
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, FL, USA
| | - Leonardo F Ferreira
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
- Center for Exercise Science, University of Florida, Gainesville, FL, USA
| | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, FL, USA
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, FL, USA
| | - Terence E Ryan
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.
- Center for Exercise Science, University of Florida, Gainesville, FL, USA.
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20
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Kuusik K, Kepler T, Zilmer M, Eha J, Vähi M, Kals J. Effects of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Lower Limb Angiographic Procedures: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg 2019; 58:875-882. [PMID: 31648881 DOI: 10.1016/j.ejvs.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/09/2019] [Accepted: 06/09/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Remote ischaemic preconditioning (RIPC) is a phenomenon that promotes protection of tissues and organs against ischaemia reperfusion injury. RIPC has been shown to reduce myocardial and renal injury but its effect on arterial stiffness in patients undergoing lower limb digital subtraction angiography (DSA) is unknown. The aim of this study was to evaluate the effect of RIPC on arterial stiffness in patients with peripheral arterial disease (PAD) undergoing lower limb DSA. METHODS In the RIPC intervention, the blood pressure cuff on the arm was inflated to 200 mmHg or to 20 mmHg above systolic pressure, and in the sham intervention to 20 mmHg. For both, the procedure was repeated for four five minute cycles at five minute intervals between the cycles. Changes in heart rate corrected augmentation index (AIx@75), augmentation index (AIx), carotid femoral pulse wave velocity (PWV), and haemodynamic parameters were measured before and 24 h after DSA. RESULTS 111 (RIPC 54, sham 57) patients with symptomatic lower limb PAD scheduled for DSA were randomised. 102 patients (RIPC 47, sham 55) were included in final analysis. RIPC significantly improved AIx (-5.46% in RIPC and -1.45% in sham group; p = .05), but not AIx@75 (-4.88% in RIPC and -1.38% in sham group; p = .07) or PWV (-0.41 m/s in RIPC and -0.27 m/s in sham group; p = .74). In the RIPC group a significant reduction in AIx (p = .002) and AIx@75 (p = .003) was noted after stenting when compared with the sham intervention. AIx (p = .001), AIx@75 (p = .002), mean arterial (p = .01), peripheral (p = .02), and central systolic blood pressure (p = .006) were significantly reduced only in the RIPC group 24 h after DSA. CONCLUSION This study evaluates for the first time the effects of RIPC on arterial stiffness parameters in patients with symptomatic PAD following DSA. RIPC may modulate arterial stiffness following a DSA procedure and is more pronounced in patients after stent placement.
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Affiliation(s)
- Karl Kuusik
- Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Heart Clinic, Tartu University Hospital, Tartu, Estonia; Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia.
| | - Teele Kepler
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Mihkel Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Jaan Eha
- Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Heart Clinic, Tartu University Hospital, Tartu, Estonia
| | - Mare Vähi
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Jaak Kals
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Department of Vascular Surgery, Surgery Clinic, Tartu University Hospital, Tartu, Estonia
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Karanfil M, Akbuğa K, Yayla Ç, Ertem AG, Unal S, Açar B, Demirtaş K, Akdi A, Ozeke Ö. Nicorandil and Contrast-Induced Nephropathy. Angiology 2019; 71:189. [PMID: 31185721 DOI: 10.1177/0003319719855156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Kürşat Akbuğa
- Department of Cardiology, Ufuk University Medical Faculty, Ankara, Turkey
| | - Çağrı Yayla
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | | | - Sefa Unal
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Burak Açar
- Department of Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Koray Demirtaş
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Akdi
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Özcan Ozeke
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
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22
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Bolt LJJ, Sigterman TA, Krasznai AG, Sikkink CJJM, Schurink GWH, Bouwman LH. Prevention of postcontrast acute kidney injury after percutaneous transluminal angioplasty by inducing RenalGuard controlled furosemide forced diuresis with matched hydration: study protocol for a randomised controlled trial. BMJ Open 2018; 8:e021842. [PMID: 30287607 PMCID: PMC6173231 DOI: 10.1136/bmjopen-2018-021842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Percutaneous transluminal angioplasty (PTA) is often complicated due to postcontrast acute kidney injury (PC-AKI) in patients diagnosed with chronic kidney disease (CKD). Hydration therapy is the cornerstone in the prevention of PC-AKI. Furosemide forced diuresis with matched hydration using the RenalGuard system enables a steady balance between diuresis and hydration. A randomised controlled trial will be performed in order to investigate whether furosemide forced diuresis with matched hydration in combination with the RenalGuard system decreases incidence of PC-AKI in patients with CKD receiving a PTA of the lower extremities. Furthermore, we will investigate whether sampling of urine biomarkers 4 hours after intervention can detect PC-AKI in an earlier stage compared with the golden standard, serum creatinine 48-72 hours postintervention. METHODS AND ANALYSIS A single-centre randomised controlled trial will be conducted. Patients >18 years in need of a PTA of the lower extremities and diagnosed with CKD will be randomly assigned to receive either standard of care prehydration and posthydration or furosemide forced diuresis with matched hydration periprocedural using the RenalGuard system. Four hours postintervention, a urine sample will be collected of all participating patients. Serum creatinine will be sampled within 10 days prior to intervention as well as 1, 3 and 30 days postintervention. The primary endpoint is incidence of PC-AKI post-PTA. Secondary endpoint is the rise of urine biomarkers 4 hours postintervention. ETHICS AND DISSEMINATION Study protocol is approved by the research ethics committee and institutional review board (reference number 16 T-201 and NL59809.096.16). Study results will be disseminated by oral presentation at conferences and will be submitted to a peer-reviewed journal. It is anticipated that study results will offer a solution to contrast-induced nephropathy in patients with CKD receiving a PTA of the lower extremities. TRIAL REGISTRATION NUMBER NTR6236; Pre-results. EUDRACT NUMBER 2016-005072-10.
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Affiliation(s)
- Lars J J Bolt
- Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, The Netherlands
| | | | - Atilla G Krasznai
- Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, The Netherlands
| | - Cees-Jan J M Sikkink
- Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, The Netherlands
| | | | - Lee Hans Bouwman
- Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, The Netherlands
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23
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Increased transforming growth factor beta (TGF-β) and pSMAD3 signaling in a Murine Model for Contrast Induced Kidney Injury. Sci Rep 2018; 8:6630. [PMID: 29700311 PMCID: PMC5919895 DOI: 10.1038/s41598-018-24340-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/26/2018] [Indexed: 01/14/2023] Open
Abstract
We tested the hypothesis that post-contrast acute kidney injury (PC-AKI) occurs due to increase in transforming growth factor beta (Tgf-β) and pSMAD3 signaling in a murine model of PC-AKI. Mice had nephrectomy performed and twenty-eight days later, 100-μL of radio-contrast (Vispaque 320) or saline was administered via the jugular vein. Animals were sacrificed at 2, 7, and 28 days later and the serum BUN, creatinine, urine protein levels, and kidney weights were assessed. In human kidney-2 (HK-2) cells, gene and protein expression with cellular function was assessed following inhibition of TGFβR-1 plus contrast exposure. After contrast administration, the average serum creatinine is significantly elevated at all time points. The average gene expression of connective tissue growth factor (Ctgf), Tgfβ-1, matrix metalloproteinase-9 (Mmp-9), and collagen IVa (Col IVa) are significantly increased at 2 days after contrast administration (P < 0.05). Cellular proliferation is decreased and there is increased apoptosis with tubulointerstitial fibrosis. Contrast administered to HK-2 cells results in increased pSMAD3 levels and gene expression of Ctgf, Tgfβ-1, Tgfβ-2, Col IVa, Mmp-9, and caspase/7 activity with a decrease in proliferation (all, P < 0.05). TGFβR-1 inhibition decreased the expression of contrast mediated pro-fibrotic genes in HK-2 cells with no change in the proliferation and apoptosis.
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Affiliation(s)
- Mitchell H Rosner
- From the Division of Nephrology, University of Virginia Health System, Charlottesville
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Cury MVM, Matielo MF, Brochado Neto FC, Soares RDA, Adami VL, Morais JDF, Futigami AY, Sacilotto R. The Incidence, Risk Factors, and Outcomes of Contrast-Induced Nephropathy In Patients With Critical Limb Ischemia Following Lower Limb Angiography. Angiology 2018; 69:700-708. [PMID: 29390867 DOI: 10.1177/0003319718754984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intra-arterial digital subtraction angiography (DSA) is commonly used for the diagnosis and treatment of patients with critical limb ischemia (CLI). The aim of this study was to analyze the incidence of contrast-induced nephropathy (CIN) in patients with CLI and to assess their outcomes. Between May 2013 and May 2014, a prospective and observational study was conducted with 107 patients admitted exclusively for CLI treatment. The main outcomes included hemodialysis independence (HI) and overall survival (OS), as assessed by Kaplan-Meier curves. Overall, there was a predominance of males (57%), with a mean age of 70.5 (10.7) years. The incidence of CIN was 35.5%, and chronic kidney failure was the only factor associated with elevated risk of this condition (relative risk [RR] = 1.9; 95% confidence interval = 1.17-3.09; P = .017). The median follow-up was 645 days, and in 720-day analyses, patients who experienced CIN had worse HI (81.2% vs 96.3%; P = .0107) and OS (49.5% vs 66.3%; P = .0463). The current study found a high incidence of CIN in patients with CLI after DSA. This renal impairment was associated with a worse prognosis in terms of survival.
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Affiliation(s)
- Marcus Vinícius Martins Cury
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Marcelo Fernando Matielo
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Francisco Cardoso Brochado Neto
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Rafael de Athayde Soares
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Vinícius Lopes Adami
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Jalíese Dantas Fernandes Morais
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Aline Yoshimi Futigami
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
| | - Roberto Sacilotto
- 1 Department of Vascular and Endovascular Surgery, São Paulo State Public Servants Hospital (HSPE), Vila Clementino, São Paulo, Brazil
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Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention. J Vasc Interv Radiol 2017; 28:1687-1692. [PMID: 28947366 DOI: 10.1016/j.jvir.2017.07.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To determine incidence, predictors, and clinical outcomes of postcontrast acute kidney injury (PC-AKI) following renal artery stent placement for atherosclerotic renal artery stenosis. MATERIALS AND METHODS This retrospective study reviewed 1,052 patients who underwent renal artery stent placement for atherosclerotic renal artery stenosis; 437 patients with follow-up data were included. Mean age was 73.6 years ± 8.3. PC-AKI was defined as absolute serum creatinine increase ≥ 0.3 mg/dL or percentage increase in serum creatinine ≥ 50% within 48 hours of intervention. Logistic regression analysis was performed to identify risk factors for PC-AKI. The cumulative proportion of patients who died or went on to hemodialysis was determined using Kaplan-Meier survival analysis. RESULTS Mean follow-up was 71.1 months ± 68.4. PC-AKI developed in 26 patients (5.9%). Patients with PC-AKI had significantly higher levels of baseline proteinuria compared with patients without PC-AKI (odds ratio = 1.38; 95% confidence interval, 1.11-1.72; P = .004). Hydration before intervention, chronic kidney disease stage, baseline glomerular filtration rate, statin medications, contrast volume, and iodine load were not associated with higher rates of PC-AKI. Dialysis-free survival and mortality rates were not significantly different between patients with and without PC-AKI (P = .50 and P = .17, respectively). CONCLUSIONS Elevated baseline proteinuria was the only predictor for PC-AKI in patients undergoing renal artery stent placement. Patients who developed PC-AKI were not at greater risk for hemodialysis or death.
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Reichetzeder C, Heunisch F, Einem G, Tsuprykov O, Kellner KH, Dschietzig T, Kretschmer A, Hocher B. Pre-Interventional Kynurenine Predicts Medium-Term Outcome after Contrast Media Exposure Due to Coronary Angiography. Kidney Blood Press Res 2017; 42:244-256. [DOI: 10.1159/000477222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/08/2017] [Indexed: 11/19/2022] Open
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Ozkok S, Ozkok A. Contrast-induced acute kidney injury: A review of practical points. World J Nephrol 2017; 6:86-99. [PMID: 28540198 PMCID: PMC5424439 DOI: 10.5527/wjn.v6.i3.86] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/21/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) is one of the most common causes of AKI in clinical practice. CI-AKI has been found to be strongly associated with morbidity and mortality of the patients. Furthermore, CI-AKI may not be always reversible and it may be associated with the development of chronic kidney disease. Pathophysiology of CI-AKI is not exactly understood and there is no consensus on the preventive strategies. CI-AKI is an active research area thus clinicians should be updated periodically about this topic. In this review, we aimed to discuss the indications of contrast-enhanced imaging, types of contrast media and their impact on nephrotoxicity, major pathophysiological mechanisms, risk factors and preventive strategies of CI-AKI and alternative non-contrast-enhanced imaging methods.
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Martínez-Rico C, Martí-Mestre X, Romera-Villegas A, Espinar-Garcia E, Iborra-Ortega E, Vila-Coll R. Contrast-Induced Nephropathy: A Fact or Fiction in Lower Limb Revascularization? Ann Vasc Surg 2017; 44:277-281. [PMID: 28479456 DOI: 10.1016/j.avsg.2017.03.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/02/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Contrast-induced nephropathy (CIN) is defined as an increase >25% of serum creatinine from baseline, occurring in 24-48 hours after exposure to contrast, while alternative explanations for renal impairment have been excluded. The volume administered directly relates to risk, increasing by 12% per 100 mL of contrast. According to the series, its incidence varies between 3.3% and 8% in patients without renal damage and 12-50% in patients with chronic kidney disease (CKD) and/or diabetes mellitus (DM). The purpose of this study is to determine the incidence of CIN in endovascular revascularization of lower limbs in our center, where we apply the ALARA concept (As Low As Reasonably Achievable) to the use of contrast. MATERIAL AND METHODS 163 patients who underwent endovascular revascularization procedures in lower limbs were included in this prospective observational study between February 2013 and April 2015. They were classified according to clinical stage and presence of DM and/or CKD. Data included serum creatinine values preoperative and postoperative, type and volume of contrast used. Patients on hemodialysis and those without sufficient analytical data were excluded. Chi-squared test and Student t-test were used for data analysis. P < 0.05 was considered statistically significant. RESULTS 109 patients were enrolled, with 67% of DM and 31.5% of CKD. CIN incidence was 3.7% in patients without DM neither CKD, in DM was 6.8% and 12.5% in CKD. Mean creatinine presurgery was 97.96 and postsurgery 97.07, finding no significant differences between them (P = 0.753). Medium-contrast volume was 37.43 mL ± 22.3. The worsening variable (creatinine postsurgery minus creatinine presurgery) was evaluated according to clinical stage, DM, or CKD, being not significant in either group. CONCLUSIONS In our experience, the dose administered of contrast was not related to the existence of postprocedure CIN, due to the policy of optimizing the use of contrast.
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Affiliation(s)
- Carlos Martínez-Rico
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | - Xavier Martí-Mestre
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Romera-Villegas
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Emma Espinar-Garcia
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Iborra-Ortega
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón Vila-Coll
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Sun XP, Li J, Zhu WW, Li DB, Chen H, Li HW, Chen WM, Hua Q. Platelet to Lymphocyte Ratio Predicts Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology 2017; 69:71-78. [PMID: 28464698 DOI: 10.1177/0003319717707410] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We investigated the relationship between platelet to lymphocyte ratio (PLR) and contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). We enrolled 5719 patients in 3 tertiary hospitals from January 2005 to December 2010. The PLR was calculated as the ratio of platelet to lymphocyte counts on admission. Serum creatinine level was measured before and within 72 hours after contrast medium administration. To evaluate the relation between PLR and CIN, the 5719 patients were divided into a CIN group and a non-CIN group. Contrast-induced nephropathy occurred in 252 (4.4%) patients. Patients in the CIN group had significantly higher PLR than those in the non-CIN group (173.8 [62.3] and 116.2 [51.7], respectively; P < .001). In logistic regression analysis, PLR was an independent predictor of CIN (odds ratio: 1.432, 95% confidence interval: 1.205-1.816, P = .031), along with age, diabetes mellitus, creatinine, estimated glomerular filtration rate, and neutrophil to lymphocyte ratio. In conclusion, a higher PLR was an independent risk factor for the development of CIN in patients with STEMI undergoing pPCI.
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Affiliation(s)
- Xi-Peng Sun
- 1 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- 1 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei-Wei Zhu
- 1 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dong-Bao Li
- 2 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- 2 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-Wei Li
- 2 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wen-Ming Chen
- 3 Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Qi Hua
- 1 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Sigterman TA, Bolt LJJ, Krasznai AG, Snoeijs MG, Heijboer R, Schurink GWH, Bouwman LH. Loss of kidney function in patients with critical limb ischemia treated endovascularly or surgically. J Vasc Surg 2016; 64:362-368. [PMID: 27139786 DOI: 10.1016/j.jvs.2016.03.409] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Acute kidney injury after the administration of contrast material during endovascular procedures for peripheral arterial disease generally recovers with supportive treatment. However, long-term effects of endovascular procedures for critical limb ischemia on renal function remain to be investigated. METHODS This retrospective observational cohort study included all patients who newly presented to the vascular surgery outpatient clinic with Rutherford class 4 to class 6 peripheral arterial disease and who were treated with either endovascular or surgical interventions. Changes in estimated glomerular filtration rate (eGFR) after 1 year were compared between the two types of intervention. Multivariate linear regression analysis was done to correct for potential confounders. RESULTS One year after treatment, eGFR was reduced by 15.0 mL/min (95% confidence interval [CI], 13.1-17.0; P < .001) after endovascular interventions (n = 209) and by 7.6 mL/min (95% CI, 5.1-10.0; P < .001) after surgical therapy (n = 81). Although eGFR rates decreased in both groups, loss of renal function was significantly greater in patients after endovascular interventions (P < .001). Furthermore, 77% of patients receiving endovascular interventions experienced fast renal decline (defined as >4 mL/min loss of eGFR within 1 year) compared with 54% of patients treated surgically (P < .001). After correction for potential confounders, endovascular intervention was associated with 7.4 mL/min (95% CI, 5.4-9.3; P < .001) greater loss of renal function compared with patients treated surgically. CONCLUSIONS Endovascular procedures for critical limb ischemia are associated with clinically relevant permanent long-term loss of kidney function. This loss of renal function is greater than in comparable patients who were treated with open surgery.
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Affiliation(s)
- Tim A Sigterman
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
| | - Lars J J Bolt
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Attila G Krasznai
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Maarten G Snoeijs
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Roel Heijboer
- Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Lee H Bouwman
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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Rancic Z. Commentary on ‘Contrast Induced Nephropathy and Long-term Renal Decline After Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease’. Eur J Vasc Endovasc Surg 2016; 51:394. [DOI: 10.1016/j.ejvs.2015.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/12/2015] [Indexed: 11/15/2022]
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Koch C, Chaudru S, Jaquinandi V, Mahé G, Raoult H. Re. "Contrast Induced Nephropathy and Long-term Renal Decline After Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease". Eur J Vasc Endovasc Surg 2016; 51:605. [PMID: 26854210 DOI: 10.1016/j.ejvs.2015.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/25/2015] [Indexed: 11/16/2022]
Affiliation(s)
- C Koch
- CHU Rennes, Imagerie, Rennes, France
| | - S Chaudru
- INSERM, Centre d'investigation Clinique CIC 1414, Rennes, France
| | | | - G Mahé
- INSERM, Centre d'investigation Clinique CIC 1414, Rennes, France; CHU Rennes, Imagerie Cœur-Vaisseaux, Rennes, France.
| | - H Raoult
- CHU Rennes, Imagerie, Rennes, France
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