Contrast-induced acute kidney injury in patients after thoracic aortic replacement

Introduction. According to modern concepts, the development of contrast-induced acute kidneys injury after endovascular interventions can negatively affect the results of treatment and can also increase the mortality level. Objective. To evaluate the incidence of contrast-induced acute kidney injury and its impact on treatment results of patients after endovascular replacement of the breast department aorta. Materials and methods. The study included 107 patients who underwent endovascular thoracic aortic replacement. Patients were divided into two groups: the first group with contrast induced acute kidney injury patients and the second group where patients were without any renal damages. Every patient was assessed for age, comorbid status, serum creatinine level and glomerular filtration rate (before intervention, after 24, 48, 72 hours and before discharge). The risk of developing CI-AKI was assessed using the R. Mehran scale. Results. Of all the selected patients, CI-AKI was diagnosed in 20 (18.7 %). The amount of patients with concomitant chronic obstructive pulmonary disease (p = 0.04), post-infarction cardiosclerosis (p = 0.05), chronic heart failure (p = 0.02), ejection fraction left ventricle less than 40 % (p = 0.016) and kidney diseases (p = 0.002) in the first group was significantly more than in the second group. According to the results of multivariate regression analysis of independent risk factors for the development of contrast-induced kidney damage were the patient’s age (OR 1.076; 95 % CI [1.00–1.15]; p = 0.0049) and the volume of used contrast used liquid (OR 1.019; 95 % CI [1.01–1.03]; p = 0.001). Conclusion. Despite the high incidence of contrast-induced acute injury kidneys after endoprosthetics of the thoracic aorta the postoperative period for patients can be evaluated as favorable. The patient’s age and contrast volume are the risk factors for the development of the postoperation complications.

1. Paraskevas KI, Geroulakos G, Vlahakos DV. Contrast-induced nephropathy after endovascular aneurysm repair, carotid and peripheral interventions //Current Vascular Pharmacology. 2020;18(5):531–532.

2. Drews JD, Patel HJ, Williams DM, et al. The impact of acute renal failure on early and late outcomes after thoracic aortic endovascular repair //The Annals of thoracic surgery. 2014;97(6):2027–2033.

3. Jeon YH, Bae CH. The risk factors and outcomes of acute kidney injury after thoracic endovascular aortic repair //The Korean Journal of Thoracic and Cardiovascular Surgery. 2016;49(1):15–21.

4. Upchurch JrGR, Escobar GA, Azizzadeh A, et al. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms //Journal of vascular surgery. 2021;73(1):55S–83S.

5. Kawatani Y, Kurobe H, Nakamura Y, et al. The ratio of contrast medium volume to estimated glomerular filtration rate as a predictor of contrast-induced nephropathy after endovascular aortic repair //The Journal of Medical Investigation. 2018;65(1.2):116–121.

6. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury //Nephron Clinical Practice. 2012;120(4):179–184.

7. Mironova OYu, Sivakova OA, Fomin VV. Contrastinduced nephropathy in patients with stable coronary artery disease and one-year prognosis //Eurasian Journal of Cardiology. 2020;3:100–105. In Russian

8. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation //Journal of the American College of Cardiology. 2004;44(7):1393–1399.

9. Lavrishcheva YuV, Konradi AO0, Yakovenko AA, Zakharov MV. Methodological aspects of prevention of contrast-induced acute kidney injury in angiographic studies and interventions using radiopaque drugs // Translyatsionnaya medicina=Translational medicine. 2020;7(4):83–90. In Russian

10. Aryev AL, Chesnokov AA, Dzakhova SD, et al. Multimorbidity as one of the predictors of the risk of developing contrast-induced nephropathy in geriatric practice // Nefrologiya=Nephrology. 2017;21(1):34–38. In Russian.

11. Sinitsyn VE, Filatova DA, Mershina EA. Contrast-induced acute renal injury: the current state of the issue // Medicinskaya vizualizaciya=Medical imaging. 2022;26(1):27–39. In Russian.

12. Wu MY, Lo WC, Wu YC, et al. The incidence of contrast-induced nephropathy and the need of dialysis in patients receiving angiography: A systematic review and meta-analysis //Frontiers in Medicine. 2022;9:862534.

13. Chen SW, Lee KB, Napolitano MA, et al. Complications and management of the thoracic endovascular aortic repair //Aorta. 2020;8(03):049–058.