This article is more than 5 years old. Information may no longer be current.
Acute kidney injury rate after carotid artery stenting higher in CKD
Click Here to Manage Email Alerts
Patients with chronic kidney disease who undergo carotid artery stenting have a higher rate of acute kidney injury, which may be associated with hemodynamic depression, according to recent findings.
Moreover, acute kidney injury (AKI) appears to increase the risk for major adverse events within 30 days of stenting, the researchers wrote.
The study included 126 patients with chronic kidney disease (CKD) who were scheduled to undergo carotid artery stent implantation at the Clinica Mediterranea, Naples, Italy, between February 2009 and September 2013. Stenting procedures were performed without the use of general anesthesia or sedation, and all patients received self-expanding stents. Patients received 1 mg of IV atropine prior to balloon post-dilation to reduce hemodynamic depression, defined as periprocedural systolic BP below 90 mm Hg or a heart rate below 60 beats per minute.
The researchers measured serum creatinine 1 day prior to the procedure and at 24 hours, 48 hours and 1 week after administration of contrast media. They used the Mehran score to determine independent risk for contrast-induced AKI, and evaluated the incidence of hemodynamic depression, AKI and 30-day major adverse events, including death, stroke and MI.
Twenty-six patients (21%) developed AKI. Those with AKI had similar baseline kidney function and contrast volume to those who did not, but also had a higher Mehran risk score (10 ± 3 vs. 8 ± 3; P = .032) and a higher rate of hemodynamic depression (65% vs. 35%; P = .005), which the researchers wrote was primarily attributable to hypotension. The threshold of the duration of hemodynamic depression for development of AKI was 2.5 minutes (sensitivity, 54%; specificity, 82%). Hemodynamic depression (OR = 4.01; 95% CI, 1.07-15.03), Mehran risk score (OR = 1.29; 95% CI, 1.03-1.6) and male gender (OR = 6.07; 95% CI, 1.18-31.08) were identified as factors independently predictive of AKI.
In-hospital and 30-day major adverse events were more common among patients with AKI vs. those without (19.5% vs. 7%; P = .058). AKI (OR = 4.83; 95% CI, 1.1-21.24) and hemodynamic depression (OR = 5.58; 95% CI, 1.1-28.31) were independent predictors of major events, according to the researchers.
“In CKD patients undergoing [carotid artery stenting], hemodynamic depression but not [contrast media] volume represents an independent predictor of AKI; and AKI is associated with a higher 30-day major adverse events rate,” they wrote. “Further studies are needed to assess whether preventing hemodynamic depression will reduce the AKI rate and therefore improve outcome following [carotid artery stenting].” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts