Contrast Induced Acute Kidney Injury in High-Risk patients undergoing Peripheral Vascular Interventions
Satinderjit Locham, Alejandra Rodriguez, Brittany Strauss, Adam Doyle, Roan Glocker, Jennifer Ellis, Doran Mix, Michael Stoner
University of Rochester Medical Center, Rochester, NY
INTRODUCTION: Patients with chronic kidney disease (CKD) are at a higher risk of developing acute kidney injury (AKI) following peripheral vascular interventions (PVIs). Very few studies in vascular surgery have looked at the role of intravenous hydration or C02 angiography in this high-risk population. Thus, the aim of this study is to use a large national vascular database to evaluate the use of these adjuncts in preventing contrast induced AKI.
METHODS: Glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation, which was used to identify high-risk patients with CKD stage 4-6. Only patients undergoing elective PVIs in the Vascular Quality Initiative (VQI) from 2017 to 2021 were included. Use of adjuncts including intravenous hydration and C02 angiography were studied. Primary outcome of the study was AKI defined in VQI as rise in creatinine (>0.5 mg/dl) or requiring new dialysis. Only patients with at least 1 to 3 days of length of stay were included given it takes approximately 24-72 hours for creatinine to rise following administration of iodinated contrast. Standard univariate and multivariable (logistic regression) analysis were utilized for statistical analysis.
RESULTS: A total of 3,946 patients were identified. Of which, 67% received prophylactic hydration. Patients receiving prophylaxis were more likely to have higher Rutherford classification 4-6 (67.7% vs. 60.3%)(P<0.001). No significant difference was seen in AKI (1.2% vs. 0.9%) and contrast volume (mean (S.D.): 65.02(51.33) vs. 64.89(48.13) milliliters)(both P>0.05) between two groups. Total fluoroscopy time was significantly higher in patients receiving prophylaxis (mean (S.D.): 19.22(15.30) vs. 18.10(14.05) minutes, P=0.03). After adjusting for significant covariates, no difference was seen in AKI between patients receiving prophylaxis versus none (OR (95% CI): 1.30(0.64-2.62), p=0.47). Severity of CKD was the only predictor of AKI (table). In a subset analysis, use of CO2 angiography was also not associated with reducing AKI (OR (95%CI): 1.07(0.52-2.21), P=0.85).
CONCLUSIONS: This is the first study using a large national vascular database to demonstrate that the use of adjuncts (CO2 angiography or hydration) in high-risk CKD patients is not associated with reducing renal complications following peripheral vascular interventions. 
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