Efficacy and safety of endovascular therapy by diluted contrast digital subtraction angiography in patients with chronic kidney disease

  • Naoki HayakawaEmail author
  • Satoshi Kodera
  • Noriyoshi Ohki
  • Junji Kanda
Original Article


This study was performed to evaluate the efficacy and safety of endovascular therapy (EVT) by diluted contrast digital subtraction angiography (DSA) in patients with chronic kidney disease (CKD). Patients with peripheral artery disease (PAD) often have CKD; thus, EVT carries a risk of contrast-induced nephropathy (CIN). Reducing the amount of contrast medium is, therefore, important in these patients. We developed a novel EVT method using DSA with diluted contrast medium. DSA parameters were adjusted for diluted contrast angiography (1:10 dilution), and we defined this technique as low-concentration DSA (LC-DSA). We retrospectively analyzed 122 patients with CKD [estimated glomerular filtration rate (eGFR), < 45 mL/min/1.73 m2] from June 2012 to November 2017 and classified them into two groups: EVT with diluted contrast (LC-DSA group, n = 63) and conventional EVT (control group, n = 59). Patients with aortoiliac lesions and those undergoing hemodialysis were excluded. The primary endpoint was the incidence of CIN as defined by an absolute increase in serum creatinine of ≥ 0.5 mg/dL or relative increase of ≥ 25% 2–5 days after the procedure. The secondary endpoints were worsening renal function (defined as an eGFR reduction of ≥ 25% compared with that before the procedure), the amount of contrast medium used for EVT, freedom from complications related to LC-DSA, and procedural success. The incidence of CIN was significantly lower in the LC-DSA group than control group (0.0% vs. 11.9%, respectively; P = 0.001). The absolute eGFR increase (4.25 ± 4.7 vs. 1.24 ± 6.9, respectively; P = 0.005) and creatinine decrease ( − 0.16 ± 0.2 vs. 0.007 ± 0.34, respectively; P = 0.0078) were greater in the LC-DSA group than control group. Less contrast medium was used in the LC-DSA group than control group (30.0 ± 14.6 vs. 117.9 ± 52.8 mL, respectively; P < 0.0001). There were no differences in the procedural success rate (100% vs. 96.6%, P = 0.23) or complications related to LC-DSA (0.0% vs. 1.7%, P = 0.48). Therefore, we concluded that EVT with diluted contrast DSA reduced the amount of contrast medium and incidence of CIN. This method is effective and safe for treating patients with CKD who have infrainguinal lesions.


Diluted contrast medium Chronic kidney disease Endovascular therapy Contrast-induced nephropathy Digital subtraction angiography 



We thank Angela Morben, DVM, ELS, from Edanz Group (, for editing a draft of this manuscript.


This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare no potential conflicts of interest regarding the research, authorship, and/or publication of this article.

Research ethics

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all patients.


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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Naoki Hayakawa
    • 1
    Email author
  • Satoshi Kodera
    • 1
    • 2
  • Noriyoshi Ohki
    • 3
  • Junji Kanda
    • 1
  1. 1.Department of Cardiovascular MedicineAsahi General Hospital ChibaJapan
  2. 2.Department of Cardiovascular MedicineUniversity of Tokyo HospitalTokyoJapan
  3. 3.Department of RadiologyAsahi General HospitalChibaJapan

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