Panos Kougias1, Briauna Lowery1, Sherene Sharath1, Peter H. Lin2, Carlos Bechara1, George Pisimisis1, Taemee Pak2, Neal R. Barshes1
1Surgery, Michael E. DeBakey VAMC, Houston, TX; 2Baylor College of Medicine, Houston, TX.
OBJECTIVES: Patients with occlusive or aneurysmal vascular disease are repeatedly exposed to intravenous (IV) contrast for diagnostic or therapeutic purposes. We sought to determine the long-term impact of cumulative iodinated IV contrast exposure (CIVCE) on renal function, the latter defined with National Kidney Foundation (NKF) criteria.
METHODS: We conducted a longitudinal analysis on consecutive patients without renal insufficiency at baseline (NFK Stage I or II) who underwent interventions for arterial occlusive or aneurysmal disease. We collected detailed data on any IV iodinated contrast exposure (including diagnostic or therapeutic angiography, cardiac catheterization, IV pyelography, computed tomography (CT) with IV contrast and CT angiography); medication exposure throughout the observation period; comorbidities; and demographics. Primary endpoint was the development of renal failure (RF) (defined as NFK Stage 4 or 5). Analysis was performed using a Cox regression frailty model with clustering at the patient level.
RESULTS: Patients (n=1298) had a mean follow-up of 5.8 (range: 2.2-14) years. In the multivariate model, with RF as dependent variable, and after adjusting for the statistically significant covariates of baseline renal function (HR: 0.94, p<0.001), age (HR: 0.42, p<0.001), diabetes (HR: 2.2, p=0.013), and congestive heart failure (HR: 3.2, p<0.001), CIVCE remained an independent predictor of RF development (HR: 1.15, p<0.001). In the multivariate survival analysis model, and after adjusting for the statistically significant covariates of the newly developed RF (HR: 5.1, p<0.001), perioperative myocardial infarction (HR: 5.2, p=0.004), age (HR: 1.5, p=0.01), total number of open operations (HR: 2.1, p<0.001) and serum albumin (HR: 0.4, p<0.001), CIVCE was an independent predictor of mortality (HR: 1.14, p<0.001).
CONCLUSIONS: Cumulative IV iodinated contrast exposure is an independent predictor of renal failure and mortality in patients with occlusive and aneurysmal vascular disease.
AUTHOR DISCLOSURES: N. R. Barshes: Nothing to disclose; C. Bechara: Nothing to disclose; P. Kougias: Nothing to disclose; P. H. Lin: Nothing to disclose; B. Lowery: Nothing to disclose; T. Pak: Nothing to disclose; G. Pisimisis: Nothing to disclose; S. Sharath: Nothing to disclose.
Posted April 2013