Contrast-Associated Acute Kidney Injury in Patients with and without Diabetes Mellitus Undergoing Computed Tomography Angiography and Local Thrombolysis for Acute Lower Limb Ischemia
Butt, Talha LU ; Lehti, Leena LU ; Apelqvist, Jan LU ; Gottsäter, Anders LU and Acosta, Stefan LU
(2022)
In Vascular and Endovascular Surgery
56(2).
p.151-157
- Abstract
Repetitive iodinated contrast media exposure may be harmful for the kidneys. The aim of the present study was to evaluate if patients with diabetes mellitus (DM) undergoing CT angiography (CTA) and local continuous thrombolysis for acute lower limb ischemia (ALI) had an increased risk of developing contrast-associated acute kidney injury (CA-AKI) compared to patients without DM. Methods: This is a retrospective study of patients undergoing CTA and local continuous thrombolysis due to ALI between 2001 and 2018. CA-AKI was defined as a 25% increase in serum creatinine within 72 hours after latest contrast administration. Results: There was no difference (P =.30) in the frequency of CA-AKI between patients with (27.9%; n = 43) and without... (More)
Repetitive iodinated contrast media exposure may be harmful for the kidneys. The aim of the present study was to evaluate if patients with diabetes mellitus (DM) undergoing CT angiography (CTA) and local continuous thrombolysis for acute lower limb ischemia (ALI) had an increased risk of developing contrast-associated acute kidney injury (CA-AKI) compared to patients without DM. Methods: This is a retrospective study of patients undergoing CTA and local continuous thrombolysis due to ALI between 2001 and 2018. CA-AKI was defined as a 25% increase in serum creatinine within 72 hours after latest contrast administration. Results: There was no difference (P =.30) in the frequency of CA-AKI between patients with (27.9%; n = 43) and without DM (20.6%; n = 170). Among patients with CA-AKI, patients with DM had a lower (P <.001) estimated glomerular filtration rate (eGFR) at discharge (55 ml/min/1.73 m2) than at admission (70 ml/min/1.73 m2), while no such difference was found in the group without DM (P =.20). The gram-iodine dose/eGFR ratio was higher (P <.001) in patients with CA-AKI (median 1.49, [IQR 1.34-1.81]) than in those who did not develop CA-AKI (median 1.05 [IQR 1.00-1.13]). There was a trend that gram-iodine dose/eGFR ratio (OR 1.42/standard deviation increment, 95% CI 1.00-2.02; P =.050) was associated with an increased risk of CA-AKI, after adjusting for DM, age, and gender. Conclusions: The frequency of CA-AKI was high after CTA and local continuous thrombolysis for ALI without shown increased frequency for the DM group. Among patients with CA-AKI, however, patients with DM had worse renal function at discharge than those without DM. The gram-iodine dose/eGFR ratio in these patients needs to be lower to improve renal outcomes, particularly in patients with DM.
(Less)
- author
- Butt, Talha
LU
; Lehti, Leena
LU
; Apelqvist, Jan
LU
; Gottsäter, Anders
LU
and Acosta, Stefan
LU
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- acute lower limb ischemia, computed tomography angiography, contrast-associated acute kidney injury, diabetes mellitus, glomerular filtration rate, intra-arterial thrombolysis
- in
- Vascular and Endovascular Surgery
- volume
- 56
- issue
- 2
- pages
- 151 - 157
- publisher
- SAGE Publications
- external identifiers
-
- pmid:34670450
- scopus:85117508693
- ISSN
- 1538-5744
- DOI
- 10.1177/15385744211051503
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © The Author(s) 2021.
- id
- 3a161b9c-427c-42b1-b07b-d552cca3eae4
- date added to LUP
- 2021-11-18 11:54:11
- date last changed
- 2024-06-15 20:53:09
@article{3a161b9c-427c-42b1-b07b-d552cca3eae4,
abstract = {{<p>Repetitive iodinated contrast media exposure may be harmful for the kidneys. The aim of the present study was to evaluate if patients with diabetes mellitus (DM) undergoing CT angiography (CTA) and local continuous thrombolysis for acute lower limb ischemia (ALI) had an increased risk of developing contrast-associated acute kidney injury (CA-AKI) compared to patients without DM. Methods: This is a retrospective study of patients undergoing CTA and local continuous thrombolysis due to ALI between 2001 and 2018. CA-AKI was defined as a 25% increase in serum creatinine within 72 hours after latest contrast administration. Results: There was no difference (P =.30) in the frequency of CA-AKI between patients with (27.9%; n = 43) and without DM (20.6%; n = 170). Among patients with CA-AKI, patients with DM had a lower (P <.001) estimated glomerular filtration rate (eGFR) at discharge (55 ml/min/1.73 m<sup>2</sup>) than at admission (70 ml/min/1.73 m<sup>2</sup>), while no such difference was found in the group without DM (P =.20). The gram-iodine dose/eGFR ratio was higher (P <.001) in patients with CA-AKI (median 1.49, [IQR 1.34-1.81]) than in those who did not develop CA-AKI (median 1.05 [IQR 1.00-1.13]). There was a trend that gram-iodine dose/eGFR ratio (OR 1.42/standard deviation increment, 95% CI 1.00-2.02; P =.050) was associated with an increased risk of CA-AKI, after adjusting for DM, age, and gender. Conclusions: The frequency of CA-AKI was high after CTA and local continuous thrombolysis for ALI without shown increased frequency for the DM group. Among patients with CA-AKI, however, patients with DM had worse renal function at discharge than those without DM. The gram-iodine dose/eGFR ratio in these patients needs to be lower to improve renal outcomes, particularly in patients with DM.</p>}},
author = {{Butt, Talha and Lehti, Leena and Apelqvist, Jan and Gottsäter, Anders and Acosta, Stefan}},
issn = {{1538-5744}},
keywords = {{acute lower limb ischemia; computed tomography angiography; contrast-associated acute kidney injury; diabetes mellitus; glomerular filtration rate; intra-arterial thrombolysis}},
language = {{eng}},
number = {{2}},
pages = {{151--157}},
publisher = {{SAGE Publications}},
series = {{Vascular and Endovascular Surgery}},
title = {{Contrast-Associated Acute Kidney Injury in Patients with and without Diabetes Mellitus Undergoing Computed Tomography Angiography and Local Thrombolysis for Acute Lower Limb Ischemia}},
url = {{http://dx.doi.org/10.1177/15385744211051503}},
doi = {{10.1177/15385744211051503}},
volume = {{56}},
year = {{2022}},
}