title: Risk of contrast induced nephropathy in diabetic patients affected by critical limb ischemia and diabetic foot ulcers treated by percutaneous transluminal angioplasty of lower limbs.
abstract: The aim of this study is to evaluate the risk of contrast induced nephropathy (CIN) in diabetic patients with critical limb ischemia (CLI) and foot ulcers (FUs) treated by percutaneous transluminal angioplasty of lower limbs.
  
  
  
  The study group was composed of 145 diabetic patients who underwent a limb salvage protocol because of CLI and FUs between 2012 and 2015. All patients received a prophylactic strategy against the administration of contrast medium. Serum creatinine (SCr) levels were evaluated the day of procedure and for 3 days after. CIN was considered in case of increase of 25% of SCr in comparison to baseline value or an absolute increase of at least 0.5 mg/dl without other interfering factors.
  
  
  
  CIN occurred in 9% (14/145) of the cases. In the 1-year follow-up SCr returned to baseline values in 10 patients (71 %), 3 patients died (21%), and 1 patient had a major cardiovascular event (7%). No patients required dialysis. The risk was independent of chronic kidney disease stage. The rate of contrast nephropathy in each stage (X = 0.27) was as follows: 3/20 (15%) in stage 2; 3/66 (4.6%) in stage 3, 7/51 (13.7%) in stage 4; and 1/8 (12.5%) in stage 5. At the univariate analysis factors predicting this risk were anemia (HR 95% 2.5 [CI 1.8-4.2] P = .039) and heart failure (HR 95% 2.6 [CI 2.1-4.6] P = .038), while any significant variable was found at multivariate analysis.
  
  
  
  Peripheral percutaneous transluminal angioplasty in diabetic patients with CLI and FUs can be performed with a good safety factor and a low risk of contrast medium toxicity.
authors: Medicina dei Sistemi, Università di Tor Vergata, Roma, Italia.
authors: Marco
authors: M
authors: Meloni
authors: Medicina dei Sistemi, Università di Tor Vergata, Roma, Italia.
authors: Laura
authors: L
authors: Giurato
authors: Medicina dei Sistemi, Università di Tor Vergata, Roma, Italia.
authors: Valentina
authors: V
authors: Izzo
authors: Radiologia Interventistica, Università di Tor Vergata, Roma, Italia.
authors: Matteo
authors: M
authors: Stefanini
authors: Radiologia Interventistica, Università di Tor Vergata, Roma, Italia.
authors: Roberto
authors: R
authors: Gandini
authors: Medicina dei Sistemi, Università di Tor Vergata, Roma, Italia.
authors: Luigi
authors: L
authors: Uccioli
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D017719:Diabetic Foot / Q000150:complications / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000209:etiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D011379:Prognosis; D012307:Risk Factors
chemical_list: D003287:Contrast Media
keywords: contrast nephropathy; critical limb ischemia; diabetes; diabetic foot; percutaneous transluminal angioplasty