title: Iloprost as an acute kidney injury-triggering agent in severely atherosclerotic patients.
abstract: BACKGROUND
  Iloprost, a stable prostacyclin analog, is used as a rescue therapy for severe peripheral arterial disease (PAD). It has systemic vasodilatory and anti-aggregant effects, with severe vasodilatation potentially causing organ ischaemia when severe atherosclerosis is the underlying cause. In this study, we retrospectively analysed renal outcomes after iloprost infusion therapy in 86 patients.
  
  
  METHODS
  Eighty-six patients with PAD who received iloprost infusion therapy were retrospectively analysed. Clinical and biochemical parameters were recorded before (initial, Cr1), during (third day, Cr2), and after (14th day following the termination of infusion therapy, Cr3) treatment. Acute kidney injury (AKI) was defined according to KDIGO guidelines as a ≥ 0.3 mg/dl (26.52 µmol/l) increase in creatinine levels from baseline within 48 hours.
  
  
  RESULTS
  Cr2 (1.46 ± 0.1 mg/dl) (129.06 ± 8.84 µmol/l) and Cr3 (1.53 ± 0.12 mg/dl) (135.25 ± 10.61 µmol/l) creatinine levels were significantly higher compared to the initial value (1.15 ± 0.6 mg/dl) (101.66 ± 53.04 µmol/l). AKI was observed in 36 patients (41.86%) on the third day of iloprost infusion. Logistic regression analysis revealed smoking and not using acetylsalicylic acid as primary predictors (p = 0.02 and p = 0.008, respectively) of AKI during iloprost treatment. On the third infusion day, patients' urinary output significantly increased (1813.30 ± 1123.46 vs 1545.17 ± 873.00 cm3) and diastolic blood pressure significantly decreased (70.07 ± 15.50 vs 74.14 ± 9.42 mmHg) from their initial values.
  
  
  CONCLUSIONS
  While iloprost treatment is effective in patients with PAD who are not suitable for surgery, severe systemic vasodilatation can cause renal ischaemia, resulting in nonoliguric AKI. Smoking, no acetylsalicylic acid use, and lower diastolic blood pressure are the clinical risk factors for AKI during iloprost treatment.
authors.affiliation: Department of Internal Medicine, Baskent University, Ankara, Turkey. Email: mehtap94@yahoo.com.
authors.forename: Mehtap Erkmen
authors.initials: ME
authors.lastname: Uyar
authors.affiliation: Department of Internal Medicine, Baskent University, Ankara, Turkey.
authors.forename: Piril
authors.initials: P
authors.lastname: Yucel
authors.affiliation: Department of Internal Medicine, Baskent University, Ankara, Turkey.
authors.forename: Sena
authors.initials: S
authors.lastname: Ilin
authors.affiliation: Department of Internal Medicine, Baskent University, Ankara, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Bal
authors.affiliation: Department of Internal Medicine, Baskent University, Ankara, Turkey.
authors.forename: Saliha
authors.initials: S
authors.lastname: Yildirim
authors.affiliation: Department of Anesthesiology, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey.
authors.forename: Ahmet Senol
authors.initials: AS
authors.lastname: Uyar
authors.affiliation: Department of Cardiovascular Surgery, Baskent University, Ankara, Turkey.
authors.forename: Tankut
authors.initials: T
authors.lastname: Akay
authors.affiliation: Department of Nephrology, Baskent University, Ankara, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Tutal
authors.affiliation: Department of Nephrology, Baskent University, Ankara, Turkey.
authors.forename: Siren
authors.initials: S
authors.lastname: Sezer
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D001241:Aspirin / Q000627:therapeutic use; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D016285:Iloprost / Q000008:administration & dosage / Q000009:adverse effects*; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D065840:Protective Factors; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D003404:Creatinine; D016285:Iloprost; D001241:Aspirin