title: Contrast Induced Nephropathy and Long-term Renal Decline After Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease.
abstract: OBJECTIVE
  Administration of iodinated contrast media during endovascular procedures for peripheral arterial disease (PAD) may cause contrast induced nephropathy (CIN). The aim of the present study was to establish the incidence of CIN after these procedures and to study its association with long-term loss of kidney function, cardiovascular events, and death.
  
  
  METHODS
  Consecutive patients first presenting with symptomatic PAD (Rutherford classification II-VI) who were treated with an endovascular procedure were included in this prospective observational cohort study. CIN was defined as >25% increase of serum creatinine concentration from baseline at 5 days after the intervention.
  
  
  RESULTS
  Some 337 patients were included with a mean estimated glomerular filtration rate (eGFR) of 67 mL/minute. Thirteen percent (95% confidence interval [CI] 9-16) of these patients developed CIN after endovascular interventions for PAD. One year after treatment, eGFR was reduced by 12.4 mL/minute (95% CI 8.6-16.2) in patients with CIN compared with 6.2 mL/minute (95% CI 4.9-7.0) in patients without acute kidney injury (p < .01). After correction for potential confounders, CIN was associated with a 7.8 mL/minute (95% CI 4.5-11.0) reduction of eGFR at 1 year after endovascular intervention (p < .01). Furthermore, patients with CIN were at increased risk of long-term cardiovascular events and mortality.
  
  
  CONCLUSIONS
  Exposure to iodinated contrast media during endovascular procedures for symptomatic PAD frequently results in CIN. Patients with CIN are at increased risk of long-term loss of renal function, cardiovascular events, and death.
authors.affiliation: Atrium Medical Center Parkstad Heerlen, Heerlen, The Netherlands. Electronic address: timsigterman@gmail.com.
authors.forename: T A
authors.initials: TA
authors.lastname: Sigterman
authors.affiliation: Atrium Medical Center Parkstad Heerlen, Heerlen, The Netherlands.
authors.forename: A G
authors.initials: AG
authors.lastname: Krasznai
authors.affiliation: Atrium Medical Center Parkstad Heerlen, Heerlen, The Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: Snoeijs
authors.affiliation: Atrium Medical Center Parkstad Heerlen, Heerlen, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Heijboer
authors.affiliation: Maastricht University Medical Centre, Department of Surgery, Maastricht, The Netherlands.
authors.forename: G W H
authors.initials: GW
authors.lastname: Schurink
authors.affiliation: Atrium Medical Center Parkstad Heerlen, Heerlen, The Netherlands.
authors.forename: L H
authors.initials: LH
authors.lastname: Bouwman
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000628:therapy; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D003287:Contrast Media
keywords: Cardiovascular events; Contrast induced nephropathy; Endovascular interventions; Mortality; Peripheral arterial disease; Renal decline