Contrast-induced nephropathy in patients undergoing endovascular peripheral vascular intervention: Incidence, risk factors, and outcomes as observed in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.

Abstract

BACKGROUND:

The incidence, risk factors, and outcomes associated with Contrast-induced nephropathy (CIN) after Percutaneous Vascular Intervention (PVI) in contemporary medical practice are largely unknown.

METHODS:

A total of 13 126 patients undergoing PVI were included in the analysis. CIN was defined as an increase in serum creatinine from pre-PVI baseline to post-PVI peak Cr of ≥0.5 mg/dL.

RESULTS:

CIN occurred in 3% (400 patients) of the cohort, and 26 patients (6.5%) required dialysis. Independent predictors of CIN were high and low body weight, diabetes, heart failure, anemia, baseline renal dysfunction, critical limb ischemia, and a higher acuity of the PVI procedure and a contrast dose that was greater than three times the calculated creatinine clearance (CCC) (adjusted OR 1.4, 95% CI: 1.1-1.8, P = 0.003). CIN was strongly associated with adverse outcome including in-hospital death (adjusted OR 18.1, CI 10.7-30.6, P < 0.001), myocardial infarction (adjusted OR 16.2, CI 8.9-29.5, P < 0.001), transient ischemic attack/stroke (adjusted OR 5.5, CI 3.2-14.9, P = 0.001), vascular access complications (adjusted OR 3.4, CI 2.3-5, P < 0.001), and transfusion (adjusted OR 7, CI 5.4-9, P < 0.001). Hospital stay was longer in patients who developed CIN versus those who did not.

CONCLUSIONS:

CIN is not an uncommon complication associated with PVI, can be reliably predicted from pre-procedural variables, including a contrast dose of greater than three times the CCC and is strongly associated with the risk of in-hospital death, MI, stroke, transfusion, and increased hospital length of stay.

• Authors: P Michael Grossman, Syed S Ali, Herbert D Aronow, Michael Boros, Timothy J Nypaver, Theodore L Schreiber, Yeo Jung Park, Peter K Henke, Hitinder S Gurm
• Journal: Journal of interventional cardiology (J Interv Cardiol) Vol. 30 Issue 3 Pg. 274-280 (Jun 2017) ISSN: 1540-8183 [Electronic] United States
• PMID: 28370487 (Publication Type: Journal Article)
• Copyright: © 2017, Wiley Periodicals, Inc.

Chemical References

• Contrast Media

Topics

• Aged
• Blue Cross Blue Shield Insurance Plans (statistics & numerical data)
• Catheterization, Peripheral (adverse effects, methods, statistics & numerical data)
• Cohort Studies
• Contrast Media (administration & dosage, adverse effects)
• Female
• Humans
• Incidence
• Kidney Diseases (chemically induced, epidemiology)
• Male
• Michigan (epidemiology)
• Middle Aged
• Outcome and Process Assessment, Health Care
• Peripheral Arterial Disease (diagnosis, surgery)
• Prognosis
• Quality Improvement
• Risk Assessment
• Risk Factors