title: Contrast-induced nephropathy in patients undergoing endovascular peripheral vascular intervention: Incidence, risk factors, and outcomes as observed in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
abstract: BACKGROUND
  The incidence, risk factors, and outcomes associated with Contrast-induced nephropathy (CIN) after Percutaneous Vascular Intervention (PVI) in contemporary medical practice are largely unknown.
  
  
  METHODS
  A total of 13 126 patients undergoing PVI were included in the analysis. CIN was defined as an increase in serum creatinine from pre-PVI baseline to post-PVI peak Cr of ≥0.5 mg/dL.
  
  
  RESULTS
  CIN occurred in 3% (400 patients) of the cohort, and 26 patients (6.5%) required dialysis. Independent predictors of CIN were high and low body weight, diabetes, heart failure, anemia, baseline renal dysfunction, critical limb ischemia, and a higher acuity of the PVI procedure and a contrast dose that was greater than three times the calculated creatinine clearance (CCC) (adjusted OR 1.4, 95% CI: 1.1-1.8, P = 0.003). CIN was strongly associated with adverse outcome including in-hospital death (adjusted OR 18.1, CI 10.7-30.6, P < 0.001), myocardial infarction (adjusted OR 16.2, CI 8.9-29.5, P < 0.001), transient ischemic attack/stroke (adjusted OR 5.5, CI 3.2-14.9, P = 0.001), vascular access complications (adjusted OR 3.4, CI 2.3-5, P < 0.001), and transfusion (adjusted OR 7, CI 5.4-9, P < 0.001). Hospital stay was longer in patients who developed CIN versus those who did not.
  
  
  CONCLUSIONS
  CIN is not an uncommon complication associated with PVI, can be reliably predicted from pre-procedural variables, including a contrast dose of greater than three times the CCC and is strongly associated with the risk of in-hospital death, MI, stroke, transfusion, and increased hospital length of stay.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan.
authors.forename: P Michael
authors.identifier: http://orcid.org/0000-0002-2754-0344
authors.initials: PM
authors.lastname: Grossman
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan.
authors.forename: Syed S
authors.initials: SS
authors.lastname: Ali
authors.affiliation: Michigan Heart, Ann Arbor, Michigan.
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.affiliation: Munson Medical Center, Traverse City, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Boros
authors.affiliation: Division of Vascular Surgery, Henry Ford Health System, Detroit, Michigan.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Nypaver
authors.affiliation: Detroit Medical Center Cardiovascular Institute, Detroit, Michigan.
authors.forename: Theodore L
authors.initials: TL
authors.lastname: Schreiber
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Yeo Jung
authors.initials: YJ
authors.lastname: Park
authors.affiliation: Section of Vascular Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan.
authors.forename: Hitinder S
authors.identifier: http://orcid.org/0000-0002-1646-0218
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D000368:Aged; D054598:Blue Cross Blue Shield Insurance Plans / Q000706:statistics & numerical data; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D058996:Quality Improvement; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D003287:Contrast Media
keywords: contrast-induced nephropathy; peripheral arterial disease; peripheral vascular interventon; quality improvement