Impact of peripheral arterial occlusive disease on the development of contrast medium-induced acute kidney injury.

BACKGROUND/AIMS: Contrast medium-induced acute kidney injury (CI-AKI) is an important complication following the use of iodinated contrast media. It accounts for a significant number of hospital-acquired acute kidney injuries and is associated with increased in-hospital and long-term mortality and immense health care costs. We evaluated whether the presence of peripheral arterial occlusive disease (PAD) affects the incidence of CI-AKI following heart catheterization.

METHODS: The impact of PAD on the frequency of CI-AKI after heart catheterization was analysed in the prospective single-centre Dialysis-versus-Diuresis trial (January 2001 to July 2004). The patients were retrospectively divided into 3 subgroups: patients with coronary heart disease (CHD), patients with PAD and patients without PAD or CHD.

RESULTS: 412 patients were included (83.5% men, 29.1% diabetes mellitus, 4.9% ejection fraction <35%). Of these, 251 (60.9%) suffered from CHD but not from PAD, 77 (18.7%) from PAD and 84 (20.4%) had neither CHD nor PAD. After heart catheterization, 49 (11.9 %) patients developed CI-AKI. Patients with PAD suffered significantly more often from CI-AKI than those without PAD (32.7 vs. 16.8%, p = 0.008). Multivariate analyses by logistic regression confirmed PAD to be an independent predictor of a CI-AKI (odds ratio 2.013, 95% confidence interval 1.009-4.016, p = 0.047). The CHD was not significantly associated with CI-AKI.

CONCLUSION: Patients with PAD significantly more often develop a CI-AKI after heart catheterization than those without PAD.