Interarm Blood Pressure Difference as a Predictor of Contrast-Induced Acute Kidney Injury in Patients Undergoing Peripheral Vascular Interventions

Öz

Background: Contrast-induced acute kidney injury (CI-AKI) can be a serious complication for patients with peripheral artery disease(PAD) undergoing peripheral vascular interventions(PVI). An interarm blood pressure difference (IABPD)≥10 mmHg has been identified as an independent risk factor for cardiovascular disease and mortality. This study aimed to evaluate the predictive value of IABPD for the risk of CI-AKI in PAD patients undergoing PVI. Materials and Methods: This prospective study included 171 consecutive patients who underwent PVI. IABPD was defined as the difference in systolic blood pressure between the two arms and was considered significant if it was≥10 mmHg. Patients were categorized into two groups based on the occurrence of CI-AKI. Results: The incidence of CI-AKI after PVI was 21 %. The CI-AKI(+) group had a significantly higher incidence of IABPD >10 mmHg (28% vs. 8%, p<0.001). Multivariable logistic regression analysis identified IABPD (OR:1.135, 95% CI:1.037-1.243, p=0.006) as an independent predictor of CI-AKI. Additionally, hypertension (OR:2.308, 95% CI:1.091-4.885, p=0.03), higher mean blood pressure (OR:1.055, 95% CI 1.001-1.111, p=0.04), lower eGFR (OR 0.963, 95% CI 0.948-0.978, p<0.001), higher CRP levels (OR:1.028, 95% CI:1.006-1.050, p=0.01), and lower LVEF (OR:0.969, 95% CI 0.938-0.998, p=0.04) were significant predictors of CI-AKI. Furthermore, having TASC C-D lesions compared to TASC A-B was associated with a higher risk of CI-AKI (OR:3.304, 95% CI 1.197-9.117, p=0.02). Conclusions: This study demonstrated that IABPD is significantly associated with the development of CI-AKI in patients undergoing PVI for PAD. Assessing IABPD in patients before PVI could help clinicians identify those at an elevated risk for developing CI-AKI. Keywords: Contrast-induced acute kidney injury, Interarm blood pressure difference, Peripheral artery dis-ease, Peripheral vascular intervention

Anahtar Kelimeler

• contrast-induced acute kidney injury
• interarm blood pressure difference
• peripheral artery disease
• peripheral vascular intervention

Periferik Vasküler Girişim Uygulanan Hastalarda Kontrast Nefropatisinin Bir Prediktörü Olarak Kollar Arası Kan Basıncı Farkı

Öz

Amaç: Kontrast nefropatisi (KN), periferik arter hastalığı (PAH) nedeniyle periferik vasküler girişim (PVI) uygu-lanan hastalarda ciddi bir komplikasyon olabilir. İki kol arasındaki kan basıncı farkı (IABPD) ≥10 mmHg, kardiyo-vasküler hastalık ve mortalite için bağımsız bir risk faktörü olarak tanımlanmıştır. Bu çalışma, PAH nedeniyle PVI uygulanan hastalarda CI-AKI riskini öngörmede IABPD'nin prediktif değerini değerlendirmeyi amaçladı. Materyal ve Metod: Bu prospektif çalışmaya, PVI uygulanan 171 ardışık hasta dahil edildi. IABPD, iki kol arasın-daki sistolik kan basıncı farkı olarak tanımlandı ve ≥10 mmHg olduğu durumlarda anlamlı kabul edildi. Has-talar, KN gelişimine göre iki gruba ayrıldı. Bulgular: PVI sonrası CI-AKI insidansı %21 olarak bulundu. KN (+) grubunda, IABPD ≥10 mmHg oranı anlamlı derecede daha yüksekti (%28 vs. %8, p<0.001). Multivaryant lojistik regresyon analizi, IABPD'yi (OR: 1.135, %95 CI: 1.037-1.243, p=0.006) KN için bağımsız bir prediktör olarak tanımladı. Ayrıca, hipertansiyon (OR: 2.308, %95 CI: 1.091-4.885, p=0.03), daha yüksek ortalama kan basıncı (OR: 1.055, %95 CI: 1.001-1.111, p=0.04), daha düşük eGFR (OR: 0.963, %95 CI: 0.948-0.978, p<0.001), daha yüksek CRP seviyeleri (OR: 1.028, %95 CI: 1.006-1.050, p=0.01) ve daha düşük LVEF (OR: 0.969, %95 CI: 0.938-0.998, p=0.04) de KN için anlamlı pred-iktörler olarak bulundu. Ek olarak, TASC C-D lezyonlarına sahip olmak, TASC A-B'ye kıyasla daha yüksek KN riski ile ilişkilendirildi (OR: 3.304, %95 CI: 1.197-9.117, p=0.02). Sonuç: Bu çalışma, IABPD'nin, PAH nedeniyle PVI uygulanan hastalarda KN gelişimi ile anlamlı bir şekilde ilişkili olduğunu göstermiştir. PVI öncesinde IABPD değerlendirilmesi, KN gelişim riski yüksek olan hastaların belir-lenmesine yardımcı olabilir.

Anahtar Kelimeler

• Kontrast nefropatisi
• İki kol arasındaki kan basıncı farkı
• Periferik arter hastalığı
• Periferik vasküler girişim

Kaynakça

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