Contrast-induced nephropathy in patients with chronic kidney disease and peripheral arterial disease

BACKGROUND The risk for contrast-induced nephropathy (CIN) after intra-arterial application of an iodine-based contrast material is unknown for patients with chronic kidney disease (CKD) and peripheral arterial disease (PAD). PURPOSE To investigate the incidence of CIN in patients with CKD and PAD. MATERIAL AND METHODS This retrospective study was approved by the local ethics committee. One hundred and twenty patients with 128 procedures (73 with baseline eGFR in the range of 45-60 mL/min/1.73m(2), 55 with eGFR < 45 mL/min/1.73m(2)) were evaluated. All patients received intra-arterially an iodine-based low-osmolar contrast material (CM) after adequate intravenous hydration with isotonic NaCl 0.9% solution. CIN was defined as an increase in serum creatinine of more than 44 μmol/L within 4 days. The influence of patient-related risk factors (age, weight, body mass index, eGFR, serum creatinine, hypertension, diabetes mellitus, coronary heart disease, heart failure) and therapy-related risk factors (amount of CM, nephrotoxic drugs, number of CM applications) on CIN were examined. RESULTS CIN developed in 0% (0/73) of procedures in patients with PAD and an eGFR in the range of 45-60 mL/min/1.73m(2) and in 10.9% (6/55) of procedures in patients with an eGFR <45 mL/min/1.73m(2). No risk factor significantly influenced the development of CIN, although baseline serum creatinine (P = 0.06) and baseline eGFR (P = 0.10) showed a considerable dependency. CONCLUSION Patients with an eGFR in the range of 45-60 mL/min/1.73m(2) and PAD seem not at risk for CIN after intra-arterial CM application and adequate hydration. Whereas, an eGFR < 45 mL/min/1.73m(2) correlated with a risk of 10.9% for a CIN.