A Clinical Study To Investigate The Risk Factors Of Contrast-induced Nephropathy And The Predictors Of Long-term Outcomes After Endovascular Therapy In Patients With Peripheral Arterial Diseases

Objective:To evaluate the in-hospital incidence and investigate the risk factors for contrast-induced nephropathy(CIN) after non-emergency endovascular therapy in patients with peripheral arterial diseases.Methods:In this prospective, single center study, in-hospital patients with peripheral arterial diseases undergoing non-emergency endovascular therapy from July2010to April2011in a tertiary hospital were enrolled. CIN was defined as a25%increase from baseline value in SCr, assessed at48hours after angiography. General clinical characteristics and basic blood biochemical parameters were compared between the non-CIN and CIN group, The differential values between6,24,48hours after angiography and the baseline corresponds to serum creatinine, eGFR were compared between two groups. Logistic regression analysis was performed to reveal risk factors associated with CIN.Results:Total350patients were included in the study,73.43%of them were male, median serum creatinine, eGFR and serum cystatin C at baseline was78μmol/L、91,66mL-min-1·1.73m-2、1.10mg/L, respectively; contrast-induced nephropathy occurred in37patients(10.57%). The ratios of diabetes mellitus and premedication with diuretics, contrast-media volume were significantly higher in the CIN group than those in the non-CIN group(p=0.022、0.001and0.011). Logistic regression analysis indicated that diabetes mellitus, contrast-media volume associated with the occurrence of CIN. When the difference between the6-,12-and24-hour serum creatinine and the basal determination were calculated, significant difference was showed as early as6hours after the procedure, the non-CIN group showing a change of serum creatinine (-)6.83±13.52μmol/L, compared with12.14±26.16μmol/L in the CIN group (p=0.003); The same observation refers to the percentage changes between the values of eGFR at6,12and24hours and at baseline.Conclusions:This study implied that diabetes mellitus, contrast-media volume were important risk factors for CIN. Increments of serum creatinine compared with baseline6hours after angiography was significantly higher in CIN group; thus analysis of the variables that may enable early diagnosis. Objective:To evaluate the diagnostic and prognostic value of serum Cystatin C(CyC) and serum creatinine in CIN and long-term major adverse events after non-emergency endovascular therapy in patients with peripheral arterial diseases.Methods:In this prospective, single center study, in-hospital patients with peripheral arterial diseases undergoing non-emergency endovascular therapy from July2010to April2011in a tertiary hospital were enrolled. General clinical characteristics and blood biochemical parameters before and24h,48h after angiography prospectively were recorded. Major adverse effects(MAE) over a median follow-up period of12months were examined. In the first place, a SCr increase of≥25%in addition to several Cystatin C definitions of CIN were chosed on presentation; the conformance of these definitions in evaluating contrast-induced Acute Kidney Injury were assessed, and whether they were predictive of MAE were furthermore investigated. In order to compare prognostic value of△%SCr48h-basal and△%Cys C24h-basal, receiver-operating characteristic curves were performed. In the next place, baseline characteristics were compared between MAE and non-MAE group, Risk factors for12-months MAE were assessed by univariate Cox regression hazard analysis, and then multivariate analysis was utilized by applying multiple logistic forward Cox regression analysis to obtain independent predictors. The cumulative incidence of MAE was estimated according to the Kaplan-Meier method, and the log-rank statistic was used for comparing subjects with or without serum cystatin C increases of≥5%.Results:Total350patients were included,73.43%of them were male, median serum creatinine, eGFR and serum cystatin C at baseline was78μmol/L、91.66mL-min-1·1.73m-2、1.10mg/L, respectively.45(12.86%) patients were lost to follow-up; twenty-eleven (8.85%) of the305patients experienced a major event during the period of follow-up. Any serum Cys C increase or serum Cys C increase>5%,8%,10,15%,25%,0.20mg/L at24hours after contrast media exposure all had low sensitivity for predicting subjects with a SCr increase≥25%, small overlapped regions were found in Venn diagram between several increasing criteria according to serum Cys C and serum creatinine criterion; areas under the receiver-operating characteristic curve for△%SCr48h-basal and△%Cys C24h-basal was0.480,0.737respectively(p=0.750、<0.001). The ratios of CIN that defined as a SCr increase≥25%was not significantly different between MAE and non-MAE group, however the ratio of Any serum Cys C increase or serum Cys C increase≥5%,8%,10,15%in MAE group was significantly higher than those in non-MAE group(p<0.001、<0.001、0.003、<0.001、0.002, respectively). Basic serum creatinine and eGFR level were not associated with MAE as illustrated in univariate analysis; patients in MAE group were more likely to be older and had significantly higher serum Cys C concentration, ACys C24h-basal(p<0.001、=0.028、0.001), meanwhile those who experienced MAE had a significantly lower level of weight, DBP, basic HB, HCT, serum ALB and pre-ALB(p=0.003、0.017、0.009and<0.001of rest). In univariate Cox regression analysis older age, lower levels of HCT, serum ALB, pre-ALB and a serum cystatin C increases of≥5%were associated with a higher risk of12-months MAE; however in multiple logistic Cox regression analysis of model2, only Cys C remained as a significant predictor of MAE. As shown in the Kaplan-Meier survival analyses, elevated cystatin C level of≥5%was associated with an increased risk of MAE(Log-rank test,p<0.001).Conclusions:Among patients with peripheral arterial diseases undergoing endovascular therapy, the results of several increasing criteria according to serum Cys C and serum creatinine criterion in evaluating contrast-induced AKI were not coincident well with each others; however according to analysis of follow up, CIN that defined as a SCr increase≥25%was not associated with MAE. older age, lower levels of HCT, serum ALB, pre-ALB and experienced a serum cystatin C increases of≥5%were associated with a higher risk of12-months MAE; however only elevated cystatin C level of>5%remained as significant predictors of MAE.