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Jan Apelqvist

Physician

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Contrast-Associated Acute Kidney Injury in Patients with and without Diabetes Mellitus Undergoing Computed Tomography Angiography and Local Thrombolysis for Acute Lower Limb Ischemia

Author

  • Talha Butt
  • Leena Lehti
  • Jan Apelqvist
  • Anders Gottsäter
  • Stefan Acosta

Summary, in English

Repetitive iodinated contrast media exposure may be harmful for the kidneys. The aim of the present study was to evaluate if patients with diabetes mellitus (DM) undergoing CT angiography (CTA) and local continuous thrombolysis for acute lower limb ischemia (ALI) had an increased risk of developing contrast-associated acute kidney injury (CA-AKI) compared to patients without DM. Methods: This is a retrospective study of patients undergoing CTA and local continuous thrombolysis due to ALI between 2001 and 2018. CA-AKI was defined as a 25% increase in serum creatinine within 72 hours after latest contrast administration. Results: There was no difference (P =.30) in the frequency of CA-AKI between patients with (27.9%; n = 43) and without DM (20.6%; n = 170). Among patients with CA-AKI, patients with DM had a lower (P <.001) estimated glomerular filtration rate (eGFR) at discharge (55 ml/min/1.73 m2) than at admission (70 ml/min/1.73 m2), while no such difference was found in the group without DM (P =.20). The gram-iodine dose/eGFR ratio was higher (P <.001) in patients with CA-AKI (median 1.49, [IQR 1.34-1.81]) than in those who did not develop CA-AKI (median 1.05 [IQR 1.00-1.13]). There was a trend that gram-iodine dose/eGFR ratio (OR 1.42/standard deviation increment, 95% CI 1.00-2.02; P =.050) was associated with an increased risk of CA-AKI, after adjusting for DM, age, and gender. Conclusions: The frequency of CA-AKI was high after CTA and local continuous thrombolysis for ALI without shown increased frequency for the DM group. Among patients with CA-AKI, however, patients with DM had worse renal function at discharge than those without DM. The gram-iodine dose/eGFR ratio in these patients needs to be lower to improve renal outcomes, particularly in patients with DM.

Department/s

  • Vascular Diseases - Clinical Research
  • Genomics, Diabetes and Endocrinology
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Internal Medicine - Epidemiology
  • EpiHealth: Epidemiology for Health

Publishing year

2022

Language

English

Pages

151-157

Publication/Series

Vascular and Endovascular Surgery

Volume

56

Issue

2

Document type

Journal article

Publisher

SAGE Publications

Topic

  • Radiology, Nuclear Medicine and Medical Imaging
  • Cardiac and Cardiovascular Systems

Keywords

  • acute lower limb ischemia
  • computed tomography angiography
  • contrast-associated acute kidney injury
  • diabetes mellitus
  • glomerular filtration rate
  • intra-arterial thrombolysis

Status

Published

Research group

  • Vascular Diseases - Clinical Research
  • Genomics, Diabetes and Endocrinology
  • Internal Medicine - Epidemiology

ISBN/ISSN/Other

  • ISSN: 1538-5744