Contrast-Induced Nephropathy: A Fact or Fiction in Lower Limb Revascularization?

Autor: Antonio Romera-Villegas, Emma Espinar-Garcia, Elena Iborra-Ortega, Xavier Martí-Mestre, Ramon Vila-Coll, Carlos Martinez-Rico
Rok vydání: 2017
Předmět:
Male
Time Factors
medicine.medical_treatment
Contrast Media
030204 cardiovascular system & hematology
Radiography
Interventional
chemistry.chemical_compound
0302 clinical medicine
Risk Factors
Medicine
Prospective Studies
030212 general & internal medicine
Aged
80 and over
Incidence
Incidence (epidemiology)
Endovascular Procedures
Angiography
General Medicine
Middle Aged
Up-Regulation
Treatment Outcome
Lower Extremity
Creatinine
Female
Kidney Diseases
Hemodialysis
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Contrast-induced nephropathy
Urology
Revascularization
Nephropathy
Peripheral Arterial Disease
03 medical and health sciences
Predictive Value of Tests
Diabetes mellitus
Diabetes Mellitus
Humans
Renal Insufficiency
Chronic
Aged
Chi-Square Distribution
business.industry
medicine.disease
Surgery
chemistry
Spain
Linear Models
business
Biomarkers
Kidney disease
Zdroj: Annals of Vascular Surgery. 44:277-281
ISSN: 0890-5096
DOI: 10.1016/j.avsg.2017.03.193
Popis: 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 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.
Databáze: OpenAIRE
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