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Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention.
J Vasc Interv Radiol 2017; 28(12):1687-1692JV

Abstract

PURPOSE

To determine incidence, predictors, and clinical outcomes of postcontrast acute kidney injury (PC-AKI) following renal artery stent placement for atherosclerotic renal artery stenosis.

MATERIALS AND METHODS

This retrospective study reviewed 1,052 patients who underwent renal artery stent placement for atherosclerotic renal artery stenosis; 437 patients with follow-up data were included. Mean age was 73.6 years ± 8.3. PC-AKI was defined as absolute serum creatinine increase ≥ 0.3 mg/dL or percentage increase in serum creatinine ≥ 50% within 48 hours of intervention. Logistic regression analysis was performed to identify risk factors for PC-AKI. The cumulative proportion of patients who died or went on to hemodialysis was determined using Kaplan-Meier survival analysis.

RESULTS

Mean follow-up was 71.1 months ± 68.4. PC-AKI developed in 26 patients (5.9%). Patients with PC-AKI had significantly higher levels of baseline proteinuria compared with patients without PC-AKI (odds ratio = 1.38; 95% confidence interval, 1.11-1.72; P = .004). Hydration before intervention, chronic kidney disease stage, baseline glomerular filtration rate, statin medications, contrast volume, and iodine load were not associated with higher rates of PC-AKI. Dialysis-free survival and mortality rates were not significantly different between patients with and without PC-AKI (P = .50 and P = .17, respectively).

CONCLUSIONS

Elevated baseline proteinuria was the only predictor for PC-AKI in patients undergoing renal artery stent placement. Patients who developed PC-AKI were not at greater risk for hemodialysis or death.

Authors+Show Affiliations

Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Department of Clinical Statistics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Electronic address: misra.sanjay@mayo.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28947366

Citation

Takahashi, Edwin A., et al. "Predictors and Outcomes of Postcontrast Acute Kidney Injury After Endovascular Renal Artery Intervention." Journal of Vascular and Interventional Radiology : JVIR, vol. 28, no. 12, 2017, pp. 1687-1692.
Takahashi EA, Kallmes DF, Fleming CJ, et al. Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention. J Vasc Interv Radiol. 2017;28(12):1687-1692.
Takahashi, E. A., Kallmes, D. F., Fleming, C. J., McDonald, R. J., McKusick, M. A., Bjarnason, H., ... Misra, S. (2017). Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention. Journal of Vascular and Interventional Radiology : JVIR, 28(12), pp. 1687-1692. doi:10.1016/j.jvir.2017.07.038.
Takahashi EA, et al. Predictors and Outcomes of Postcontrast Acute Kidney Injury After Endovascular Renal Artery Intervention. J Vasc Interv Radiol. 2017;28(12):1687-1692. PubMed PMID: 28947366.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention. AU - Takahashi,Edwin A, AU - Kallmes,David F, AU - Fleming,Chad J, AU - McDonald,Robert J, AU - McKusick,Michael A, AU - Bjarnason,Haraldur, AU - Harmsen,William S, AU - Misra,Sanjay, Y1 - 2017/09/22/ PY - 2017/04/10/received PY - 2017/07/30/revised PY - 2017/07/31/accepted PY - 2017/9/28/pubmed PY - 2018/5/18/medline PY - 2017/9/27/entrez SP - 1687 EP - 1692 JF - Journal of vascular and interventional radiology : JVIR JO - J Vasc Interv Radiol VL - 28 IS - 12 N2 - PURPOSE: To determine incidence, predictors, and clinical outcomes of postcontrast acute kidney injury (PC-AKI) following renal artery stent placement for atherosclerotic renal artery stenosis. MATERIALS AND METHODS: This retrospective study reviewed 1,052 patients who underwent renal artery stent placement for atherosclerotic renal artery stenosis; 437 patients with follow-up data were included. Mean age was 73.6 years ± 8.3. PC-AKI was defined as absolute serum creatinine increase ≥ 0.3 mg/dL or percentage increase in serum creatinine ≥ 50% within 48 hours of intervention. Logistic regression analysis was performed to identify risk factors for PC-AKI. The cumulative proportion of patients who died or went on to hemodialysis was determined using Kaplan-Meier survival analysis. RESULTS: Mean follow-up was 71.1 months ± 68.4. PC-AKI developed in 26 patients (5.9%). Patients with PC-AKI had significantly higher levels of baseline proteinuria compared with patients without PC-AKI (odds ratio = 1.38; 95% confidence interval, 1.11-1.72; P = .004). Hydration before intervention, chronic kidney disease stage, baseline glomerular filtration rate, statin medications, contrast volume, and iodine load were not associated with higher rates of PC-AKI. Dialysis-free survival and mortality rates were not significantly different between patients with and without PC-AKI (P = .50 and P = .17, respectively). CONCLUSIONS: Elevated baseline proteinuria was the only predictor for PC-AKI in patients undergoing renal artery stent placement. Patients who developed PC-AKI were not at greater risk for hemodialysis or death. SN - 1535-7732 UR - https://www.unboundmedicine.com/medline/citation/28947366/Predictors_and_Outcomes_of_Postcontrast_Acute_Kidney_Injury_after_Endovascular_Renal_Artery_Intervention_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-0443(17)30749-2 DB - PRIME DP - Unbound Medicine ER -