Acute kidney injury in patients undergoing endovascular therapy for critical limb ischemia

Abstract

Background Similar to coronary angiography and interventions, patients undergoing percutaneous treatment of lower extremity peripheral arterial disease are also at risk of acute kidney injury (AKI). The incidence, risk factors associations, need for dialysis and inhospital mortality related to AKI in patients with critical limb ischemia (CLI) following endovascular therapy is poorly defined. Objectives The purpose of this study was to analyze data from the National Inpatient Sample (NIS) to determine the aforementioned outcomes in patients with CLI. Methods Using the full NIS admission dataset from 2003 through 2012, ICD‐9 codes relevant to comorbid conditions, procedure codes, composite codes for AKI, and inhospital mortality were analyzed using multivariate models. Results A total of 273,624 patients were included with a mean age of 70.0 ± 27.4 years, 46.0% were female, 57.2% had diabetes, 43.4% had coronary artery disease (CAD), and 29.2% had chronic kidney disease (CKD). The overall rate of AKI was 10.4%, and there was a temporal rise over the analysis period in AKI incidence (p < .001). Age, diabetes, CKD, and heart failure were all associated with AKI (p < .0001). The inhospital mortality rate in the patients with AKI declined over time but was higher than in patients without AKI (6.0% vs. 1.4%), p < .0001. The mortality rate was substantially higher in patients with AKI requiring dialysis as compared to AKI not requiring dialysis (13.4% vs. 5.6%), p < .0001. Conclusions AKI is associated with age, CKD, and heart failure. The incidence of AKI following endovascular therapy for CLI is rising and independently associated with inhospital mortality.

Acute kidney injury after endovascular interventions for critical limb ischemia: Is that a whole different animal?

“…In line with previous studies including patients who underwent coronary artery angiography and percutaneous coronary intervention, Prasad and colleagues report an overall incidence of AKI of 10.4% . However, the authors found also a steady increase in the incidence of AKI over time, especially from 2008 to 2012, when rates rose from 9.7 to 17.9% . AKI requiring dialysis occurred also with an increasing incidence over the study period .…”

“…In contrast, AKI‐related and all‐cause mortality rates declined over time . These findings are difficult to interpret and might have not been properly addressed in the study due to the limitations imposed by the design based on procedure and diagnosis codes . Indeed, changes and variable implementation of AKI definitions might have occurred during the study and the present dataset shows no information about variations of serum creatinine and urine output from baseline values, hydration status, application of preventive strategies, use of concomitant medications with effects on renal function, and remains unclear the influence of unmeasured procedural factors .…”

“…In this issue, Prasad and colleagues delineate the impact of AKI after 273,624 endovascular procedures for critical lower limb ischemia . In line with previous studies including patients who underwent coronary artery angiography and percutaneous coronary intervention, Prasad and colleagues report an overall incidence of AKI of 10.4% .…”

“…However, the authors found also a steady increase in the incidence of AKI over time, especially from 2008 to 2012, when rates rose from 9.7 to 17.9% . AKI requiring dialysis occurred also with an increasing incidence over the study period . In contrast, AKI‐related and all‐cause mortality rates declined over time .…”

“…AKI requiring dialysis occurred also with an increasing incidence over the study period . In contrast, AKI‐related and all‐cause mortality rates declined over time . These findings are difficult to interpret and might have not been properly addressed in the study due to the limitations imposed by the design based on procedure and diagnosis codes .…”