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

Yıl 2025, Cilt: 22 Sayı: 2, 288 - 295, 27.06.2025

Ahmet Karaduman , Cemalettin Yılmaz , İsmail Balaban , Mustafa Ferhat Keten , Muhammet Mücahit Tiryaki , Mehmet Çelik , Zeki Şimşek , Elnur Alızade

https://doi.org/10.35440/hutfd.1614779

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

Etik Beyan

This study adhered to the principles of the Declaration of Helsinki and received ethical approval from the Kartal Kosuyolu Training and Research Hospital (Approval no: 2024/19/927).

Destekleyen Kurum

None

Teşekkür

None.

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

• 1. Abaci O, Harmankaya O, Kocas B, Kocas C, Bostan C, Coskun U, et al. Long-term follow-up of patients at high risk for nephrop-athy after contrast exposure. Angiology. 2015;66(6):514- 8.
• 2. Tepel M, Aspelin P, Lameire N. Contrast-induced nephropathy: a clinical and evidence- based approach. Circulation. 2006;113(14):1799-806.
• 3. Grossman PM, Ali SS, Aronow HD, Boros M, Nypaver TJ, Schreiber TL, et al. Contrast- induced nephropathy in patients undergoing endovascular peripheral vascular intervention: in-cidence, risk factors, and outcomes as observed in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. J Interv Cardiol. 2017;30(3):274-80.
• 4. Gupta R, Gurm HS, Bhatt DL, Chew DP, Ellis SG. Renal failure after percutaneous coronary intervention is associated with high mortality. Catheter Cardiovasc Interv. 2005;64(4):442- 8.
• 5. Narula A, Stone GW, Dangas GD, Witzenbichler B, Guagliumi G, Kornowski R, et al. Impact of contrast nephropathy on long term outcomes after acute MI: three year results from HORI-ZONS-AMI study. Eur Heart J. 2011;32(2):234.
• 6. Prasad A, Ortiz-Lopez C, Khan A, Levin D, Kaye DM. Acute kidney injury following peripheral angiography and endovascu-lar therapy: a systematic review of the literature. Catheter Cardiovasc Interv. 2016;88(2):264-73.
• 7. National Institute for Health and Clinical Excellence. Hyper-tension: The Clinical Management of Primary Hypertension in Adults, CG127. London: NICE; 2011.
• 8. Clark CE, Campbell JL, Evans PH, Millward A. Prevalence and clinical implications of the inter-arm blood pressure differ-ence: a systematic review. J Hum Hypertens. 2006;20(12):923-31.
• 9. Agarwal R, Bunaye Z, Bekele DM. Prognostic significance of between-arm blood pressure differences. Hypertension. 2008;51(3):657-62. doi:10.1161/HYPERTENSIONAHA.107.104943.
• 10. Clark CE, Campbell JL, Powell RJ. The interarm blood pressure difference as predictor of cardiovascular events in patients with hypertension in primary care: cohort study. J Hum Hypertens. 2007;21(8):633-8. doi:10.1038/sj.jhh.1002209.
• 11. Tanaka Y, Fukui M, Tanaka M, Fukuda Y, Mitsuhashi K, Okada H, et al. The inter-arm difference in systolic blood pressure is a novel risk marker for subclinical atherosclerosis in patients with type 2 diabetes. Hypertens Res. 2014;37(6):548-52. doi:10.1038/hr.2014.30.
• 12. Su HM, Lin TH, Hsu PC, Chu CY, Lee WH, Chen SC, et al. Asso-ciation of interarm systolic blood pressure difference with atherosclerosis and left ventricular hypertrophy. PLoS One. 2012;7(8):e41173. doi:10.1371/journal.pone.0041173.
• 13. Baumann F, Makaloski V, Diehm N. Aortic aneurysms and aortic dissection: epidemiology, pathophysiology and diagnostics. Internist (Berl). 2013;54(5):535-42.
• 14. Wang Y, Zhang J, Qian Y, Tang X, Ling H, Kemin C, et al. Associ-ation of inter-arm blood pressure difference with asymptomat-ic intracranial and extracranial arterial stenosis in hyperten-sion patients. Sci Rep. 2016;6:29894. doi:10.1038/srep29894.
• 15. Clark CE, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012;379(9819):905-14.
• 16. Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A; Cholesterol Embolism Study (CHEST) Investigators. The inci-dence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol. 2003;42(2):211-6.
• 17. Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Généreux P, et al. Contrast-induced acute kidney injury after primary percu-taneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J. 2014;35(23):1533-40.
• 18. Ohno Y, Maekawa Y, Miyata H, Inoue S, Ishikawa S, Sueyoshi K, et al. Impact of periprocedural bleeding on incidence of con-trast-induced acute kidney injury in patients treated with per-cutaneous coronary intervention. J Am Coll Cardiol. 2013;62(14):1260-6.
• 19. Liu ZZ, Schmerbach K, Lu Y, Perlewitz A, Nikitina T, Cantow K, et al. Iodinated contrast media cause direct tubular cell dam-age, leading to oxidative stress, low nitric oxide, and impair-ment of tubuloglomerular feedback. Am J Physiol Renal Physiol. 2014;306(8):F864- 72.
• 20. Pisani A, Riccio E, Andreucci M, Faga T, Ashour M, Nuzzi AD, et al. Role of reactive oxygen species in pathogenesis of radio-contrast-induced nephropathy. Biomed Res Int. 2013;2013:868321.
• 21. Barrett BJ, Parfrey PS. Clinical practice. Preventing nephropa-thy induced by contrast medium. N Engl J Med. 2006;354(4):379-86. doi:10.1056/NEJMcp050801.
• 22. Oktay V, Calpar Çıralı İ, Sinan ÜY, Yıldız A, Ersanlı MK. Impact of continuation of metformin prior to elective coronary angi-ography on acute contrast nephropathy in patients with nor-mal or mildly impaired renal functions. Anatol J Cardiol. 2017;18(5):334-9. doi:10.14744/AnatolJCardiol.2017.7836.
• 23. Aksoy F, Aydın Baş H, Bağcı A, Basri Savaş H. Predictive value of oxidant and antioxidant status for contrast-induced nephropa-thy after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Rev Port Cardiol. 2021;40(7):489-97. doi:10.1016/j.repce.2021.07.018.
• 24. Seeliger E, Sendeski M, Rihal CS, Persson PB. Contrast-induced kidney injury: Mechanisms, risk factors, and prevention. Eur Heart J. 2012;33(16):2007-15. doi:10.1093/eurheartj/ehr494.
• 25. Yuan Y, Qiu H, Hu X, Luo T, Gao X, Zhao X, et al. Predictive value of inflammatory factors on contrast-induced acute kid-ney injury in patients who underwent an emergency percuta-neous coronary intervention. Clin Cardiol. 2017;40(10):719-25.
• 26. Gungoren F, Besli F, Tanriverdi Z, Demirbag R. Inferior vena cava assessment can predict contrast-induced nephropathy in patients undergoing cardiac catheterization: A single- center prospective study. Echocardiography. 2018;35(12):1915-21. doi:10.1111/echo.14157.
• 27. Singh GD, Brinza EK, Hildebrand J, Waldo SW, Foley TR, Laird JR, et al. Midterm outcomes after infrapopliteal interventions in patients with critical limb ischemia based on the TASC II classification of below-the-knee arteries. J Endovasc Ther. 2017;24(3):321-30.
• 28. Joo HJ, Jang DH, Yu CW, Choi YJ, Park J, Lee HJ, et al. Efficacy and safety of endovascular treatment for femoropopliteal le-sions of TASC II type C and D compared with TASC II type A and B in Korea. Vascular. 2017;25(4):351-8.
• 29. Kopitkó C, Medve L, Gondos T. The value of combined hemo-dynamic, respiratory and intra-abdominal pressure monitoring in predicting acute kidney injury after major intraabdominal surgeries. Ren Fail. 2019;41(1):150-8.
• 30. Kopitkó C, Gondos T, Fülöp T, Medve L. Reinterpreting renal hemodynamics: the importance of venous congestion and ef-fective organ perfusion in acute kidney injury. Am J Med Sci. 2020;359(4):193-205.
• 31. Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Ja-nuszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hyperten-sion. J Hypertens. 2023;41(12):1874-2071. doi:10.1097/HJH.0000000000003480.
• 32. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol. 2018;71(19):e127-248. doi:10.1016/j.jacc.2017.11.006.
• 33. Clark CE, Taylor RS, Shore AC, Campbell JL. The difference in blood pressure readings between arms and survival: primary care cohort study. BMJ. 2012;344:e1327.
• 34. Cao K, Xu J, Shangguan Q, Hu W, Li P, Cheng X, et al. Associa-tion of an inter-arm systolic blood pressure difference with all-cause and cardiovascular mortality: an updated meta- analysis of cohort studies. Int J Cardiol. 2015;189:211-9.
• 35. Durmus G, Belen E, Bayyigit A, Kalyoncuoglu M, Can MM. The relationship between inter-arm blood pressure difference and coronary artery disease severity calculated by the SYNTAX Score. Int J Hypertens. 2018;2018:9370417. doi:10.1155/2018/9370417.
• 36. Park SJ, Son JW, Hong KS, Choi HH. Effect of inter-arm blood pressure differences on outcomes after percutaneous coro-nary intervention. J Cardiol. 2020;75(6):648-53. doi:10.1016/j.jjcc.2019.12.014.
• 37. Simsek Z, Zehir R, Kalkan S, Ceneli D, Alizade E, Bayam E, et al. Inter-arm blood pressure difference is associated with con-trast-induced nephropathy in patients with ST-segment eleva-tion myocardial infarction who underwent primary percuta-neous coronary intervention. Clin Exp Hypertens. 2022;44(5):413-20. doi:10.1080/10641963.2022.2029471.