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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
  • 47 Downloads

Abstract

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.

Keywords

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

Notes

Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (https://www.edanzediting.com/ac), for editing a draft of this manuscript.

Funding

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.

References

  1. 1.
    Romano G, Briquori C, Quintavalle C, Zanca C, Rivera NV, Colombo A, Condorelli G (2008) Contrast agents and renal cell apoptosis. Eur Heart J 29:2569–2576CrossRefGoogle Scholar
  2. 2.
    Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, Conner TA, Chertow GM, Bhatt DL, Shunk K, Parikh CR, McFalls EO, Brophy M, Ferguson R, Wu H, Androsenko M, Myles J, Kaufman J, Palevsky PM; PRESERVE Trial Group (2018) Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med 378:603–614CrossRefGoogle Scholar
  3. 3.
    Isenbarger DW, Kent SM, O'Malley PG (2003) Meta-analysis of randomized clinical trials on the usefulness of acetylcysteine for prevention of contrast nephropathy. Am J Cardiol 92:1454–1458CrossRefGoogle Scholar
  4. 4.
    Hawkins IF, Cho KJ, Caridi JG (2009) Carbon dioxide in angiography to reduce the risk of contrast-induced nephropathy. Radiol Clin North Am 47:813–825CrossRefGoogle Scholar
  5. 5.
    Fujihara M, Kawasaki D, Shintani Y, Fukunaga M, Nakama T, Koshida R, Higashimori A, Yokoi Y; CO2 Angiography Registry Investigators (2015) Endovascular therapy by CO2 angiography to prevent contrast-induced nephropathy in patients with chronic kidney disease: a prospective multicenter trial of CO2 angiography registry. Catheter Cardiovasc Interv 85:870–877Google Scholar
  6. 6.
    Hayakawa N, Kodera S, Ohki N, Kushida S, Morita H, Kanda J, Komuro I (2019) Endovascular therapy using diluted contrast medium for critical limb ischemia in a patient with chronic kidney disease. Int Heart J 60(1):226–230CrossRefGoogle Scholar
  7. 7.
    Alikhani B, Jamali L, Raatschen HJ, Wacker F, Werncke T (2017) Impact of CT parameters on the physical quantities to image quality for two MDCT scanners using ACR accreditation phantom: a phantom study. Radiography 23:202–210CrossRefGoogle Scholar
  8. 8.
    Spargias K, Alexopoulos E, Kyrzopoulos S, Iokovis P, Greenwood DC, Manginas A, Voudris V, Pavlides G, Buller CE, Kremastinos D, Cokkinos DV (2004) Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. Circulation 110:2837–2842CrossRefGoogle Scholar
  9. 9.
    Spargias K, Adreanides E, Demerouti E, Gkouziouta A, Manginas A, Pavlides G, Voudris V, Cokkinos DV (2009) Iloprost prevents contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. Circulation 120:1793–1799CrossRefGoogle Scholar
  10. 10.
    Marenzi G, Marana I, Lauri G, Assanelli E, Grazi M, Campodonico J, Trabattoni D, Fabbiocchi F, Montorsi P, Bartorelli AL (2003) The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med 349:1333–1340CrossRefGoogle Scholar
  11. 11.
    Fung JW, Szeto CC, Chan WW, Kum LC, Chan AK, Wong JT, Wu EB, Yip GW, Chan JY, Yu CM, Woo KS, Sanderson JE (2004) Effect of N-acetylcysteine for prevention of contrast nephropathy in patients with moderate to severe renal insufficiency: a randomized trial. Am J Kidney Dis 43:801–808CrossRefGoogle Scholar
  12. 12.
    Fan Y, Wei Q, Cai J, Shi Y, Zhang Y, Yao L, Wang X, Lin S, Li Y, Lv J, Zhou B, Du R (2016) Preventive effect of oral nicorandil on contrast-induced nephropathy in patients with renal insufficiency undergoing elective cardiac catheterization. Heart Vessels 31:1776–1782CrossRefGoogle Scholar
  13. 13.
    Hafiz AM, Jan MF, Mori N, Shaikh F, Wallach J, Bajwa T, Allaqaband S (2012) Prevention of contrast-induced acute kidney injury in patients with stable chronic renal disease undergoing elective percutaneous coronary and peripheral interventions: randomized comparison of two preventive strategies. Catheter Cardiovasc Interv 79:929–937CrossRefGoogle Scholar
  14. 14.
    Han B, Li Y, Dong Z, Wan Q, Shen H, Li J, Wei M, Shen C (2018) Diastolic dysfunction predicts the risk of contrast-induced nephropathy and outcome post- emergency percutaneous coronary intervention in AMI patients with preserved ejection fraction. Heart Vessels 33:1149–1158CrossRefGoogle Scholar
  15. 15.
    Mariani J Jr, Guedes C, Soares P, Zalc S, Campos CM, Lopes AC, Spadaro AG, Perin MA, Filho AE, Takimura CK, Ribeiro E, Kalil-Filho R, Edelman ER, Serruys PW, Lemos PA (2014) Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (Minimizing cOntrast utilization With IVUS Guidance in coronary angioplasty) randomized controlled trial. JACC Cardiovasc Interv 7:1287–1293CrossRefGoogle Scholar
  16. 16.
    Iranirad L, Hejazi SF, Sadeghi MS, Jang SA (2017) Efficacy of nicorandil treatment for prevention of contrast-induced nephropathy in high-risk patients undergoing cardiac catheterization: a prospective randomized controlled trial. Cardiol J 24:502–507CrossRefGoogle Scholar
  17. 17.
    Cigarroa RG, Lange RA, Williams RH, Hillis LD (1989) Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 86:649–652CrossRefGoogle Scholar
  18. 18.
    Laskey WK, Jenkins C, Selzer F, Marroquin OC, Wilensky RL, Glaser R, Cohen HA, Holmes DR Jr; NHLBI Dynamic Registry Investigators (2007) Volume-to-creatinine ratio: a pharmacokinetically based risk factor for prediction of early creatine increase after percutaneous coronary intervention. J Am Coll Cardiol 50:584–590Google Scholar
  19. 19.
    Joshi SB, Mendoza DD, Steinberg DH, Goldstein MA, Lopez CF, Raizon A, Weissman G, Satler LF, Pichard AD, Weigold WG (2009) Ultra-low-dose intra-arterial contrast injection for iliofemoral computed tomographic angiography. JACC Cardiovasc Imaging 2:1404–1411CrossRefGoogle Scholar
  20. 20.
    Kawasaki D, Fujii K, Fukunaga M, Masutani M, Nakata A, Masuyama T (2012) Safety and efficacy of endovascular therapy with a simple homemade carbon dioxide delivery system in patients with iliofemoral artery disease. Circ J 76:1722–1728CrossRefGoogle Scholar
  21. 21.
    Palena LM, Diaz-Sandoval LJ, Candeo A, Brigato C, Sultato E, Manzi M (2016) Automated carbon dioxide angiography for the evaluation and endovascular treatment of diabetic patients with critical limb ischemia. J Endovasc Ther 23:40–48CrossRefGoogle Scholar
  22. 22.
    Caridi JG, Hawkins IF (1997) CO2 digital subtraction angiography: potential complications and their prevention. J Vasc Interv Radiol 8:383–391CrossRefGoogle Scholar
  23. 23.
    Oliva VL, Denbow N, Therasse E, Common AA, Harel C, Giroux MF, Soulez G (1999) Digital subtraction angiography of the abdominal aorta and lower extremities: carbon dioxide versus iodinated contrast material. J Vasc Interv Radiol 10:727–731CrossRefGoogle Scholar
  24. 24.
    Kawasaki D, Tsujino T, Fujii K, Masutani M, Ohyanagi M, Masuyama T (2008) Novel use of ultrasound guidance for recanalization of iliac, femoral, and popliteal arteries. Catheter Cardiovasc Interv 71:727–733CrossRefGoogle Scholar
  25. 25.
    Georges JL, Boueri Z, Mailler B, Nallet O, Millischer D, Faure A, Massiani PF, Belle L, Chapoutot L, Girodet B, Cattan S (2018) Reduction of radiation exposure associated with renewal of the radiologic systems in coronary interventions. Ann Cardiol Angeiol (Paris) 67:334–338CrossRefGoogle Scholar

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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