Abstract
BackgroundIodinated contrast media are amongst the most frequently prescribed medications, however, their use is not without complications. With contrast-induced nephropathy constituting a major concern, alternative non-iodine based approaches have been explored such as carbon dioxide angiography. The purpose of this study is to report the incidence of contrast-induced nephropathy following carbon dioxide angiography in patients with impaired renal function that underwent peripheral angioplasty compared with a historical cohort of patients that underwent angioplasty with use of solely iodine contrast medium. The historical cohort of patients treated with iodinated contrast was used as control. Baseline demographics and renal function tests were recorded. Primary outcome was incidence of contrast-induced nephropathy within 48–72 h post intervention. Receiver-Operating-Characteristic curve analysis was used to correlate the volume of iodinated contrast with the risk of contrast-induced nephropathy.ResultsCarbon Dioxide was used as an alternative to iodinated contrast media in patients with impaired renal function (eGFR<60mls/min/1.73 m2) undergoing peripheral angioplasty procedures. Fifty, consecutive patients (baseline eGFR = 38.6 ± 13.2mls/min/1.73 m2) were included in a prospective clinical audit. These were matched (1:2) with a historical cohort of patients (baseline eGFR = 43.3 ± 12.2mls/min/1.73 m2) treated with Iodinated contrast media. The incidence of contrast-induced nephropathy was 14% (n = 7/50) in case of carbon dioxide vs. 29% (n = 29/100) in the matched cohort group (p = 0.045). Receiver-Operating-Characteristic analysis showed that use of >25mls of contrast was 94.4% (95% CI:81–99%) sensitive in predicting contrast-induced nephropathy.ConclusionCarbon dioxide imaging during peripheral angioplasty procedures protects against contrast-induced nephropathy. Use of >25mls of iodinated contrast media in high-risk patients is a predictor of contrast-induced nephropathy.
Highlights
Iodinated contrast media are amongst the most frequently prescribed medications, their use is not without complications
The purpose of our study was to report our experience with the use of Carbon dioxide (CO2) angiography in a number of peripheral arterial disease (PAD) patients and impaired renal function that underwent peripheral angioplasty or stenting and compare the incidence of contrastinduced nephropathy (CIN) in this group with a historical cohort of chronic kidney disease (CKD) patients that underwent conventional angiographic procedures with the use of solely iodine contrast media (CM)
During the 9-month study period, all patients suffering from critical limb ischemia (CLI) referred to the interventional radiology department for peripheral arterial intervention that were considered high risk for developing CIN, underwent either exclusively CO2 angiography or combined with supplementary use of small volumes of iodine CM which was recorded in detail and included in the analysis (CO2 group)
Summary
Iodinated contrast media are amongst the most frequently prescribed medications, their use is not without complications. The purpose of this study is to report the incidence of contrast-induced nephropathy following carbon dioxide angiography in patients with impaired renal function that underwent peripheral angioplasty compared with a historical cohort of patients that underwent angioplasty with use of solely iodine contrast medium. Iodinated contrast media (CM) are amongst the most frequently prescribed medications worldwide today They are used in a large number of both diagnostic and therapeutic procedures including but not limited to peripheral angioplasty procedures and percutaneous coronary interventions. These may include allergic reactions, as well as contrastinduced nephropathy (CIN), especially in case of background chronic kidney disease (CKD). The inhospital mortality after CIN is estimated around 7% in patients who will not require dialysis and as high as 35% in patients who will eventually require dialysis (Bansal, 2014)
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