Abstract No. 133: Targeted Renal Therapy™ Reduces Acute Kidney Injury in Diabetics Undergoing Peripheral Vascular Intervention

Abstract

Contrast-induced nephropathy (CIN), the third-leading cause of hospital-acquired acute kidney injury (AKI), is associated with a longer length of hospital stay (LOS), increased healthcare costs, and higher rates of in-hospital and long-term morbidity and mortality. Previous attempts to prevent reductions in GFR due to iodinated contrast via IV vasodilator administration have been limited by systemic hypotension. We report retrospective data from the Be-RITe Registry, a multi-center, multi-disciplinary, post-market study evaluating the Benephit catheter (FlowMedica, Inc., Fremont, CA), a bifurcated catheter allowing bilateral renal artery access and simultaneous therapeutic infusion. 501 patients undergoing coronary (35%) or peripheral (54%) interventions or surgical procedures (11%) were enrolled. In 189/501 patients (71% diabetic, age 76 ± 5 yrs, CrCl 35 ± 7 ml/min) undergoing peripheral interventions involving 132 ± 45 ml of iodinated contrast media, targeted renal therapy (TRT) with fenoldopam mesylate (median dose 0.4 mcg/kg/min) was performed adjunctively via the Benephit catheter. Bilateral renal artery cannulation success was 96%. Reported CIN (≥ 25% and/or ≥ 0.5 mg/dL rise in Cr within 48 hrs) rate was 2.1% in 189 peripheral patients (vs 26.9% risk per a validated predictor, OR=0.06, p < 0.00001). Longer TRT infusions (≥ 1 hour) and higher intrarenal fenoldopam doses (≥ 0.4 mcg/kg/min) were independently associated with less CIN (both p < 0.007). Of 142 diabetic patients undergoing peripheral intervention who received TRT with fenoldopam for ≥ 1 hour at a dose of ≥ 0.4 mcg/kg/min, none developed CIN, as compared to 28.6% risk (p < 0.0001). Of the remaining 47 patients undergoing peripheral intervention, all of whom received shorter infusion times and lower fenoldopam doses, 4 patients (8.5%) developed CIN, versus a predicted rate of 21.3% (p=0.082). Bilateral renal artery infusion of vasoactive agents via the Benephit catheter adjunctive to percutaneous and surgical intervention is safe and feasible. TRT with fenoldopam adjunctive to peripheral intervention reduces the risk of AKI due to contrast and is particularly applicable for diabetic patients at high risk for CIN.