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Combined Impact of Chronic Kidney Disease and Contrast Induced Acute Kidney Injury on Long-term Outcomes in Patients with Acute Lower Limb Ischaemia.
Eur J Vasc Endovasc Surg 2018; 56(1):78-86EJ

Abstract

INTRODUCTION

Acute lower limb ischaemia (ALI) is the sudden onset of decreased arterial perfusion with imminent threat to limb viability. Contrast induced acute kidney injury (CI-AKI) is one of the complications that increases mortality in patients who undergo contrast imaging in coronary procedures. The goal of this study is to evaluate the impact of chronic kidney disease (CKD) and CI-AKI on long-term clinical outcomes in patients with ALI undergoing lower limb revascularisation.

METHODS

A total 1017 consecutive patients with acute lower limb ischaemia who were admitted between July 1, 2006, and January 1, 2017, were retrospectively reviewed. Patients who had end stage renal disease, those who had end stage heart and malignant disease and died within 7 days of limb revascularisation, and those who did not undergo angiography were excluded. Thus 546 patients were included in the final analysis. Patients were classified as with or without CKD and were then subdivided according to the presence or absence of the development of CI-AKI, defined as an increase in serum creatinine of ≥0.5 mg/dL or by ≥25% from the baseline value within the first 72 h after contrast exposure. The primary end point was all cause mortality and secondary major adverse limb event (MALE).

RESULTS

Both CKD and CI-AKI were associated with the highest rate of all cause mortality (chi square = 55.77, d.f. = 1, p < .01, log rank test) and MALE (chi square = 79.07, d.f. = 1, p < .01, log rank test). The presence of CKD and CI-AKI were significant risk factors associated with long-term all cause mortality (HR = 2.61, p < .01) and MALE (HR = 2.87, p < .01).

CONCLUSION

In patients with ALI undergoing lower limb revascularisation, both CKD and CI-AKI were significantly associated with poor long-term outcomes compared with either CKD or CI-AKI alone. Further studies are required to assess this association and to confirm the combined effect of CKD and CI-AKI on long-term clinical outcomes.

Authors+Show Affiliations

Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia. Electronic address: petarzlatanovic@yhaoo.com.Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia.Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia.Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia.Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29636253

Citation

Zlatanovic, Petar, et al. "Combined Impact of Chronic Kidney Disease and Contrast Induced Acute Kidney Injury On Long-term Outcomes in Patients With Acute Lower Limb Ischaemia." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 56, no. 1, 2018, pp. 78-86.
Zlatanovic P, Koncar I, Dragas M, et al. Combined Impact of Chronic Kidney Disease and Contrast Induced Acute Kidney Injury on Long-term Outcomes in Patients with Acute Lower Limb Ischaemia. Eur J Vasc Endovasc Surg. 2018;56(1):78-86.
Zlatanovic, P., Koncar, I., Dragas, M., Ilic, N., Sladojevic, M., Mutavdzic, P., ... Davidovic, L. (2018). Combined Impact of Chronic Kidney Disease and Contrast Induced Acute Kidney Injury on Long-term Outcomes in Patients with Acute Lower Limb Ischaemia. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 56(1), pp. 78-86. doi:10.1016/j.ejvs.2018.03.008.
Zlatanovic P, et al. Combined Impact of Chronic Kidney Disease and Contrast Induced Acute Kidney Injury On Long-term Outcomes in Patients With Acute Lower Limb Ischaemia. Eur J Vasc Endovasc Surg. 2018;56(1):78-86. PubMed PMID: 29636253.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined Impact of Chronic Kidney Disease and Contrast Induced Acute Kidney Injury on Long-term Outcomes in Patients with Acute Lower Limb Ischaemia. AU - Zlatanovic,Petar, AU - Koncar,Igor, AU - Dragas,Marko, AU - Ilic,Nikola, AU - Sladojevic,Milos, AU - Mutavdzic,Perica, AU - Tomic,Ivan, AU - Kostic,Dusan, AU - Davidovic,Lazar, Y1 - 2018/04/07/ PY - 2017/10/04/received PY - 2018/03/07/accepted PY - 2018/4/11/pubmed PY - 2018/10/30/medline PY - 2018/4/12/entrez KW - Acute lower limb ischaemia KW - Acute lower limb revascularisation KW - Chronic kidney disease KW - Contrast induced acute kidney injury SP - 78 EP - 86 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 56 IS - 1 N2 - INTRODUCTION: Acute lower limb ischaemia (ALI) is the sudden onset of decreased arterial perfusion with imminent threat to limb viability. Contrast induced acute kidney injury (CI-AKI) is one of the complications that increases mortality in patients who undergo contrast imaging in coronary procedures. The goal of this study is to evaluate the impact of chronic kidney disease (CKD) and CI-AKI on long-term clinical outcomes in patients with ALI undergoing lower limb revascularisation. METHODS: A total 1017 consecutive patients with acute lower limb ischaemia who were admitted between July 1, 2006, and January 1, 2017, were retrospectively reviewed. Patients who had end stage renal disease, those who had end stage heart and malignant disease and died within 7 days of limb revascularisation, and those who did not undergo angiography were excluded. Thus 546 patients were included in the final analysis. Patients were classified as with or without CKD and were then subdivided according to the presence or absence of the development of CI-AKI, defined as an increase in serum creatinine of ≥0.5 mg/dL or by ≥25% from the baseline value within the first 72 h after contrast exposure. The primary end point was all cause mortality and secondary major adverse limb event (MALE). RESULTS: Both CKD and CI-AKI were associated with the highest rate of all cause mortality (chi square = 55.77, d.f. = 1, p < .01, log rank test) and MALE (chi square = 79.07, d.f. = 1, p < .01, log rank test). The presence of CKD and CI-AKI were significant risk factors associated with long-term all cause mortality (HR = 2.61, p < .01) and MALE (HR = 2.87, p < .01). CONCLUSION: In patients with ALI undergoing lower limb revascularisation, both CKD and CI-AKI were significantly associated with poor long-term outcomes compared with either CKD or CI-AKI alone. Further studies are required to assess this association and to confirm the combined effect of CKD and CI-AKI on long-term clinical outcomes. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/29636253/Combined_Impact_of_Chronic_Kidney_Disease_and_Contrast_Induced_Acute_Kidney_Injury_on_Long_term_Outcomes_in_Patients_with_Acute_Lower_Limb_Ischaemia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(18)30144-8 DB - PRIME DP - Unbound Medicine ER -