Contrast-induced Nephropathy (CIN) after Peripheral Vascular Intervention (PVI): Long-term Renal Outcome and Risk Factors for Progressive Renal Dysfunction
Ziad Al Adas, MD, Kevin Lodewyk, MD, David Robinson, MD, Sherazuddin Qureshi, MD, Loay Kabbani, MD, Brian Sullivan, BS, Alexander Shepard, MD, Mitchell Weaver, MD, Timothy Nypaver, MD.
Henry Ford Hospital, Detroit, MI, USA.
Objectives: CIN is a frequently used quality outcome marker after PVIs. The long-term renal effects of CIN are unknown. This study was undertaken to investigate the late renal consequences of CIN after PVI and to identify factors associated with renal deterioration. Methods: From 2008-2015, patients who had PVI at our institution (who were part of a statewide Vascular Interventions Collaborative) were queried for those who developed CIN. CIN was defined by the collaborative as serum creatinine (Cr) increase of at least 0.5 mg/min/1.73 m2 within 30-days post-intervention. Pre-procedural dialysis patients or patients without post-procedural Cr values were excluded. Pre-procedural, post-procedural, and 1-year serum Cr values were abstracted and used to estimate glomerular filtration rate (GFR). ∆GFR was defined as pre-procedural GFR minus 1-year GFR. Univariate and multivariate analyses for ∆GFR were performed to determine factors associated with renal deterioration at 1-year. Results: From 2008-2015, 1323 PVIs were performed; 881 patients met the inclusion criteria. Of these, 57 (6.5%) developed CIN; of these, 47% were males and 51% had baseline chronic kidney disease. CIN resolved by discharge in 30 patients (53%). Using multivariate linear regression, male gender (P=0.027) and congestive heart failure (CHF) (P=0.048) were associated with 1-year GFR decline. Procedural variables related to 1-year GFR decline included percentage increase in post-procedural Cr (p=0.025) whereas CIN resolution by discharge was protective for renal function at 1-year (p=0.02). A post-hoc analysis was performed with 50 PVI patients (randomly selected) who did not develop CIN, comparing their late renal function to the CIN group stratified by the above procedural variables. Patients with CIN resolution at discharge had similar 1-year renal outcomes to non-CIN patients, while the CIN-persistent patients had greater renal deterioration at 1-year compared to non-CIN patients (P=0.037). Conclusions: Male gender and CHF are risk factors for further renal function decline in patients developing CIN after PVI. The magnitude and duration of Cr increase (CIN persistence at discharge) correlated with late progressive renal dysfunction in CIN patients. Patients who resolved CIN by discharge had similar late renal function to the patients who did not develop CIN. This suggests that early-resolving CIN is relatively benign, and that transient Cr elevations should not be considered in the CIN definition, thereby improving its clinical relevance as a quality outcome measure.
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