The Incidence, Risk Factors, and Outcomes of Contrast-Induced Nephropathy In Patients With Critical Limb Ischemia Following Lower Limb Angiography

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.

A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol: part 2—intra-arterial administration

“…PC-AKI incidence was the main outcome studied (19 studies), while the incidence of ADRs or HSRs was studied in nine studies [ 28 , 30 , 33 – 39 ]. Coronary angiography was the main type of procedure (19 studies) [ 15 – 20 , 22 – 25 , 27 , 28 , 30 – 32 , 35 , 36 , 39 ] followed by peripheral (five studies) [ 15 , 21 , 25 , 33 , 34 ] and cerebral angiography (three studies) [ 26 , 29 , 38 ] (Table 1 ).…”

“…Cury et al [ 21 ], included patients who underwent lower limb angiography for critical limb ischemia. All patients were IV hydrated with a normal saline solution before and after the procedure.…”

“…PC-AKI incidence was higher (35.5%) in patients who underwent lower limb angiography for critical limb ischemia with ioversol [ 21 ]. Likewise, a systematic review with more than 11,300 patients highlighted high incidences of PC-AKI for this type of procedures (range 0–45% and median of 10%) [ 58 ].…”

Post-contrast Acute Kidney Injury Following Emergency Transcatheter Arterial Embolization for Uncontrollable Postpartum Hemorrhage

“…Other studies involving different patient populations have reported that CIN (and even possible minor renal function impairment after contrast administration) may be associated with long-term adverse events. [27][28][29][30] New diagnostic criteria may be required for the diagnosis of PC-AKI during pregnancy; further studies are needed.…”

Digital Subtraction Angiography Prior to an Amputation for Critical Limb Ischemia (CLI): An Expert Recommendation Statement From the CLI Global Society to Optimize Limb Salvage

“…Initial evaluation with duplex ultrasonography and possibly noncontrast MRA is recommended to aid in pre-angiography planning and to decrease the likelihood of contrast-induced nephropathy. 29,35 The use of CO 2 with an automated injector can provide excellent imaging for both diagnostic and therapeutic purposes in CLI patients, allowing operators to minimize radiation and contrast exposure. 29,36,37 However, this may be true only for proximal tibial arteries; thus, general anesthesia should be considered in order to eliminate motion artifacts and obtain sufficient distal imaging quality.…”