Risk factors and safe contrast volume thresholds for postcontrast acute kidney injury after peripheral vascular interventions
Risk factors and safe contrast volume thresholds for postcontrast acute kidney injury after peripheral vascular interventions
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DOI：
10.1016/j.jvs.2019.09.059
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发表时间：
2020-08-01
影响因子：
4.3
通讯作者：
Chaar, Cassius Iyad Ochoa
中科院分区：
文献类型：
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作者：
Lee, Shin-Rong;Zhuo, Haoran;Chaar, Cassius Iyad Ochoa
目的：造影后急性肾损伤（PC-AKI）是外周血管介入治疗（PVI）的一种可怕并发症，取决于造影剂的注射量以及患者的基线肾功能。然而，目前还没有关于被认为安全的造影剂量的指导，特别是对于患有晚期慢性肾病 (CKD) 的患者。本研究旨在描述 PC-AKI 的发生率、危险因素和结果，并定义造影剂剂量的安全阈值。方法：回顾了 PVI 的血管质量倡议文件（2010-2018 年）。接受透析、肾移植或出现出血并发症的患者被排除在外。仅包含基线肌酐、造影剂容量和 PC-AKI（肌酐增加 0.5 毫克/分升或新的透析要求）完整数据的记录。得出 CKD 各阶段 PC-AKI 的累积发生率与造影剂体积的关系。造影剂体积的安全阈值定义为 PC-AKI 累积发生率等于或小于 0.5% 时的体积。使用多变量逻辑回归来定义 PC-AKI 的危险因素，并使用 Kaplan-Meier 和多变量 Cox 比例风险回归进行生存分析。结果：总共纳入 53,780 例手术。有 16,062 名肾功能正常或 CKD1 患者（29%），21,769 名患者（39%）患有 CKD2，14,234 名患者（25%）患有 CKD3，1471 名患者（3%）患有 CKD4，199 名患者患有 CKD4。
Objective: Postcontrast acute kidney injury (PC-AKI) is a dreaded complication of peripheral vascular interventions (PVIs) that depends on the volume of contrast administered as well as a patient's baseline kidney function. However, there is currently no guidance on the volume of contrast that is considered safe especially for patients with advanced chronic kidney disease (CKD). This study aims to characterize the incidence, risk factors for, and outcomes after PC-AKI and define thresholds of safety for contrast volume.Methods: The Vascular Quality Initiative files for PVI (2010-2018) were reviewed. Patients on dialysis, with renal transplants, or who developed a bleeding complication were excluded. Only records with complete data on baseline creatinine, contrast volume, and PC-AKI (creatinine increase of $0.5 mg/dL, or new dialysis requirement) were included. The cumulative incidence of PC-AKI with contrast volume at each stage of CKD was derived. A safe threshold for contrast volume was defined as the volume at which the cumulative incidence of PC-AKI is 0.5% or less. Multivariable logistic regression was used to define risk factors for PC-AKI, and survival analysis was performed using Kaplan-Meier and multivariable Cox proportional hazards regression.Results: A total of 53,780 procedures were included. There were 16,062 patients (29%) with normal kidney function or CKD1, 21,769 (39%) with CKD2, 14,234 (25%) with CKD3, 1471 (3%) with CKD4, and 199 (