title: Loss of Kidney Function after Endovascular Treatment of Peripheral Arterial Disease.
abstract: BACKGROUND
  Administration of radiocontrast during endovascular procedures for peripheral arterial disease (PAD) may cause acute kidney injury, which generally recovers with supportive treatment. Long-term effects of endovascular procedures on renal function remain to be investigated.
  
  
  METHODS
  This retrospective observational cohort study includes all patients who newly presented to the vascular surgery outpatient clinic with Rutherford class II or III PAD and who were treated with either supervised exercise therapy or endovascular interventions. Changes in estimated glomerular filtration rates (eGFR) after 1 year were compared between the 2 treatment groups. Multivariate regression analysis and propensity score-matched paired analysis were done to correct for potential confounders.
  
  
  RESULTS
  One year after treatment, eGFR was reduced by 8.6 mL/min (95% confidence interval [CI], 7.3-9.9, P < 0.001) after endovascular intervention (n = 284) and by 1.7 mL/min (95% CI, 0.9-25, P < 0.001) after supervised exercise therapy (n = 299). After correction for potential confounders, endovascular interventions were associated with 9.2 mL/min (95% CI, 5.9-12.4, P < 0.001) more renal decline compared to exercise therapy. Similar results were found in the propensity score-matched paired analysis.
  
  
  CONCLUSIONS
  Endovascular procedures for PAD are associated with clinically relevant and long-term loss of kidney function.
authors.affiliation: Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands. Electronic address: timsigterman@gmail.com.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Sigterman
authors.affiliation: Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Lars J J
authors.initials: LJJ
authors.lastname: Bolt
authors.affiliation: Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Attila G
authors.initials: AG
authors.lastname: Krasznai
authors.affiliation: Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Snoeijs
authors.affiliation: Department of Radiology, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: Heijboer
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Geert Willem H
authors.initials: GWH
authors.lastname: Schurink
authors.affiliation: Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Bouwman
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D057216:Propensity Score; D015641:Radiography, Interventional / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media