title: Impact of cumulative intravascular contrast exposure on renal function in patients with occlusive and aneurysmal vascular disease.
abstract: OBJECTIVE
  Patients with occlusive or aneurysmal vascular disease are repeatedly exposed to intravascular (IV) contrast for diagnostic or therapeutic purposes. We sought to determine the long-term impact of cumulative iodinated IV contrast exposure (CIVCE) on renal function; the latter was defined by means of National Kidney Foundation (NKF) criteria.
  
  
  METHODS
  We performed a longitudinal study of consecutive patients without renal insufficiency at baseline (NFK stage I or II) who underwent interventions for arterial occlusive or aneurysmal disease. We collected detailed data on any IV iodinated contrast exposure (including diagnostic or therapeutic angiography, cardiac catheterization, IV pyelography, computed tomography with IV contrast, computed tomographic angiography); medication exposure throughout the observation period; comorbidities; and demographics. The primary end point was the development of renal failure (RF) (defined as NFK stage 4 or 5). Analysis was performed with the use of a shared frailty model with clustering at the patient level.
  
  
  RESULTS
  Patients (n = 1274) had a mean follow-up of 5.8 (range, 2.2-14) years. In the multivariate model with RF as the dependent variable and after adjusting for the statistically significant covariates of baseline renal function (hazard ratio [HR], 0.95; P < .001), diabetes (HR, 1.8; P = .007), use of an angiotensin-converting enzyme inhibitor (HR, 0.63; P = .03), use of antiplatelets (HR, 0.5; P = .01), cumulative number of open vascular operations performed (HR, 1.2; P = .001), and congestive heart failure (HR, 3.2; P < .001), CIVCE remained an independent predictor for RF development (HR, 1.1; P < .001). In the multivariate survival analysis model and after adjusting for the statistically significant covariates of perioperative myocardial infarction (HR, 3.9; P < .001), age at entry in the cohort (HR, 1.05; P = .035), total number of open operations (HR, 1.51; P < .001), and serum albumin (HR, 0.47; P < .001), CIVCE was an independent predictor of death (HR, 1.07; P < .001).
  
  
  CONCLUSIONS
  Cumulative IV contrast exposure is an independent predictor of RF and death in patients with occlusive and aneurysmal vascular disease.
authors.affiliation: Department of Surgery, Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Surgery, Baylor College of Medicine, Houston, Tex. Electronic address: pkougias@bcm.edu.
authors.forename: Panos
authors.initials: P
authors.lastname: Kougias
authors.affiliation: Department of Surgery, Michael E. DeBakey VA Medical Center, Houston, Tex.
authors.forename: Sherene
authors.initials: S
authors.lastname: Sharath
authors.affiliation: Department of Surgery, Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
authors.affiliation: Department of Surgery, Michael E. DeBakey VA Medical Center, Houston, Tex.
authors.forename: Briauna
authors.initials: B
authors.lastname: Lowery
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Andrea
authors.initials: A
authors.lastname: Garcia
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Taemee
authors.initials: T
authors.lastname: Pak
authors.affiliation: Department of Surgery, Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Bechara
authors.affiliation: Department of Surgery, Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: George
authors.initials: G
authors.lastname: Pisimisis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging*; D000792:Angiography / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D013997:Time Factors
chemical_list: D003287:Contrast Media