title: Acute Kidney Injury in Patients With Chronic Kidney Disease Undergoing Internal Carotid Artery Stent Implantation.
abstract: OBJECTIVE
  This study sought to investigate acute kidney injury (AKI) following carotid artery stenting (CAS).
  
  
  BACKGROUND
  Few data exist on AKI following CAS.
  
  
  METHODS
  This study evaluated 126 chronic kidney disease (CKD) patients who underwent CAS. The risk for contrast-induced AKI was defined by the Mehran score. Hemodynamic depression (i.e., periprocedural systolic blood pressure <90 mm Hg or heart rate <60 beats/min), AKI (i.e., an increase of ≥0.3 mg/dl in the serum creatinine concentration at 48 h), and 30-day major adverse events (including death, stroke, and acute myocardial infarction) were assessed.
  
  
  RESULTS
  AKI occurred in 26 patients (21%). Although baseline kidney function and contrast volume were similar in the AKI group and the non-AKI group, the risk score was higher (10 ± 3 vs. 8 ± 3; p = 0.032), and hemodynamic depression (mostly due to hypotension) (65.5% vs. 35%; p = 0.005) was more common in the AKI group. The threshold of hemodynamic depression duration for AKI development was 2.5 min (sensitivity 54%, specificity 82%). Independent predictors of AKI were hemodynamic depression (odds ratio [OR]: 4.01; 95% confidence interval [CI]: 1.07 to 15.03; p = 0.009), risk score (OR: 1.29; 95% CI: 1.03 to 1.60; p = 0.024), and male sex (OR: 6.07; 95% CI: 1.18 to 31.08; p = 0.021). Independent predictors of 30-day major adverse events that occurred more often in the AKI group (19.5% vs. 7%; p = 0.058) were AKI (HR: 4.83; 95% CI: 1.10 to 21.24; p = 0.037) and hemodynamic depression (HR: 5.58; 95% CI: 1.10 to 28.31; p = 0.038).
  
  
  CONCLUSIONS
  AKI in CKD patients undergoing CAS is mostly due to hemodynamic depression and is associated with a higher 30-day major adverse events rate.
authors: Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
authors: Michael
authors: M
authors: Donahue
authors: Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
authors: Gabriella
authors: G
authors: Visconti
authors: Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
authors: Amelia
authors: A
authors: Focaccio
authors: Department of Vascular Surgery, Clinica Mediterranea, Naples, Italy.
authors: Lucio
authors: L
authors: Selvetella
authors: Department of Vascular Surgery, Clinica Mediterranea, Naples, Italy.
authors: Maria
authors: M
authors: Baldassarre
authors: Institute of Genetic and Biomedical Research, National Research Council, Milan, Italy; Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors: Chiara
authors: C
authors: Viviani Anselmi
authors: Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy. Electronic address: carlobriguori@clinicamediterranea.it.
authors: Carlo
authors: C
authors: Briguori
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D016017:Odds Ratio; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine
keywords: complication; contrast media; kidney; prevention