In the Journals

Contrast-induced nephropathy worsens long-term renal function, adverse event risk in PAD

Contrast-induced nephropathy after endovascular interventions for peripheral artery disease is associated with significantly poorer renal function and increased risk for CV events and death 1 year after treatment, according to recent results.

In a prospective, observational cohort study, researchers evaluated 337 patients with symptomatic PAD who underwent endovascular intervention at a single teaching hospital in the Netherlands between May 2013 and Feb. 15, 2014. Serum creatinine levels were measured at baseline and 5 days, 1 month and 1 year after treatment. Researchers defined contrast-induced nephropathy (CIN) as an increase in serum creatinine of more than 25% within 5 days of intervention.

The mean estimated glomerular filtration rate (eGFR) was 67 mL/minute at baseline. After intervention, 12.8% of patients developed CIN, with no patients requiring dialysis. Those who developed CIN were older (73 years vs. 67 years; P < .01) and had poorer renal function at baseline (61 mL/minute vs. 70 mL/minute; P < .01) compared with those who did not. Factors associated with CIN development of multivariate analysis included critical limb ischemia (OR = 4.8; 95% CI, 2.1-11), anemia (OR = 2.4; 95% CI, 1.1-5) and eGFR before intervention (OR = 1; 95% CI, 0.9-1).

The researchers observed a 12.4 mL/minute reduction in eGFR among patients with CIN at 1 year vs. a decrease of 6.2 mL/minute among those who did not develop acute kidney injury (P < .01). CIN was associated with a reduction of 7.8 mL/minute in eGFR at 1 year after adjustment for confounders (P < .01). Factors associated with a greater decrease in renal function included age (P = .02), critical limb ischemia (P = .02), hypertension (P < .01) and eGFR prior to intervention (P < .01).

Long-term risk for both CV events (HR = 4.2; 95% CI, 2-8.7) and mortality (HR = 4.7; 95% CI, 2.1-10.7) were significantly higher among patients who developed CIN, the researchers wrote.

“For the first time, a prospective study shows that endovascular interventions for PAD are frequently complicated by CIN, which is associated with accelerated loss of renal function and with increased risk of CV events and mortality in the first year after these interventions,” they concluded. “Prevention of CIN and increased awareness of its long-term effects may lead the way to improved patient outcomes.” – by Adam Taliercio

Disclosure: The researchers report no relevant financial disclosures.

Contrast-induced nephropathy after endovascular interventions for peripheral artery disease is associated with significantly poorer renal function and increased risk for CV events and death 1 year after treatment, according to recent results.

In a prospective, observational cohort study, researchers evaluated 337 patients with symptomatic PAD who underwent endovascular intervention at a single teaching hospital in the Netherlands between May 2013 and Feb. 15, 2014. Serum creatinine levels were measured at baseline and 5 days, 1 month and 1 year after treatment. Researchers defined contrast-induced nephropathy (CIN) as an increase in serum creatinine of more than 25% within 5 days of intervention.

The mean estimated glomerular filtration rate (eGFR) was 67 mL/minute at baseline. After intervention, 12.8% of patients developed CIN, with no patients requiring dialysis. Those who developed CIN were older (73 years vs. 67 years; P < .01) and had poorer renal function at baseline (61 mL/minute vs. 70 mL/minute; P < .01) compared with those who did not. Factors associated with CIN development of multivariate analysis included critical limb ischemia (OR = 4.8; 95% CI, 2.1-11), anemia (OR = 2.4; 95% CI, 1.1-5) and eGFR before intervention (OR = 1; 95% CI, 0.9-1).

The researchers observed a 12.4 mL/minute reduction in eGFR among patients with CIN at 1 year vs. a decrease of 6.2 mL/minute among those who did not develop acute kidney injury (P < .01). CIN was associated with a reduction of 7.8 mL/minute in eGFR at 1 year after adjustment for confounders (P < .01). Factors associated with a greater decrease in renal function included age (P = .02), critical limb ischemia (P = .02), hypertension (P < .01) and eGFR prior to intervention (P < .01).

Long-term risk for both CV events (HR = 4.2; 95% CI, 2-8.7) and mortality (HR = 4.7; 95% CI, 2.1-10.7) were significantly higher among patients who developed CIN, the researchers wrote.

“For the first time, a prospective study shows that endovascular interventions for PAD are frequently complicated by CIN, which is associated with accelerated loss of renal function and with increased risk of CV events and mortality in the first year after these interventions,” they concluded. “Prevention of CIN and increased awareness of its long-term effects may lead the way to improved patient outcomes.” – by Adam Taliercio

Disclosure: The researchers report no relevant financial disclosures.