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Incidence, risk factors for acute kidney injury after peripheral intervention unclear
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The incidence of, risk factors for and outcomes related to acute kidney injury after peripheral angiography or endovascular treatment are unknown, and there is substantial variation in the methodologies used in prior research, according to a recent analysis.
Researchers performed a systematic review of 15 studies that included detailed data on incidence of acute kidney injury (AKI) among patients who underwent lower-extremity angiography and/or interventions.
“The predictive risk factors for and clinical impact of AKI following coronary procedures have been extensively studied and documented. ... Similar data, however, are lacking for AKI following angiography or endovascular interventions for lower-extremity peripheral artery disease,” the researchers wrote.
The review involved data from 11,311 patients who underwent 10,316 peripheral endovascular procedures. The studies were published between 2003 and 2015 and included a median of 250 patients and 138 peripheral procedures.
The median rate of AKI was 10%, but the researchers observed substantial variations between the studies, with a range from 0% to 45%. The median incidence rate was also 10% when analysis was restricted to seven studies including 200 or more procedures.
The researchers also noted that the included studies varied with regard to the definition of AKI. Eight studies identified AKI as an increase in serum creatinine of 25% or more, whereas five used an absolute increase of 0.5 mg dL-1 serum creatinine, one a decrease in estimated glomerular filtration rate, one the definition used by the Acute Kidney Injury Network, and one did not report its definition.
The time of follow-up assessment also differed across the studies, ranging from 24 to 72 hours, and with no time frame reported in two studies. Three studies did not report the type of contrast used, and three did not report the volume of contrast administered. Hydration methods also varied between studies, with periprocedural volume administration in nine studies, variable fluid use in four and no reported strategy in one study.
“Given the variability of the published data, the 10% incidence of AKI is at best an estimate,” the researchers wrote. “The published PAD studies have varied in terms of their level of detail regarding severity of disease, endovascular treatments administered, method for following renal function, definition of AKI, and reporting of renal and limb-related outcomes ... Further studies to prospectively evaluate the incidence, risk factors, preventive strategies and outcomes related to AKI in this context are needed.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.
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