Deterioration of renal function is associated with increased mortality in patients with cholesterol crystal embolism

Abstract

Background and Objectives: The importance of arteriosclerotic diseases has increased in recent years owing to population aging. Increased in the incidence of catheter intervention and vascular surgery has also resulted in a corresponding increase of cholesterol crystal embolism (CCE). Patients with chronic kidney disease are often diagnosed with arteriosclerotic disease. Although the severity of CCE varies widely, because it exacerbates renal function, treatment options should be established based on CCE severity. Methods: In this retrospective study, we examined 43 patients (37 men and 6 women; mean age, 74.9 ± 7.2 years) who were admitted to our department from 2002 to 2017 because of deteriorating renal functions. We assessed these patients at admission and followed up 1-year later. Results: The causes of CCE included treatment for ischemic heart disease (41.9%), aortic aneurysm (23.3%), and the administration of warfarin (11.6%). Thirty-one patients (72.1%) were diagnosed pathologically. The mean level of creatinine (Cr) at baseline was 1.84 ± 0.83 mg/dL. The mean level of Cr on admission was 4.90 ± 2.2 mg/dL. Steroid therapy was performed in 27 patients (62.8%) and lipoprotein apheresis was performed in one patient (2.3%). During the observational period, 9 patients (20.9%) died and the increase in Cr rates was significantly higher in these individuals (P = 0.0044). After adjustment for various factors, the Cr increase rate was significantly related to mortality (hazard ratio: 2.9581, 95% confidence interval: 1.1179–7.8271, P = 0.0289). Conclusion: The deterioration rate of renal function is associated with mortality in patients with CCE, which is accompanied by renal manifestation.