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Risk of contrast induced nephropathy in diabetic patients affected by critical limb ischemia and diabetic foot ulcers treated by percutaneous transluminal angioplasty of lower limbs
Author(s) -
Meloni Marco,
Giurato Laura,
Izzo Valentina,
Stefanini Matteo,
Gandini Roberto,
Uccioli Luigi
Publication year - 2017
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2866
Subject(s) - medicine , critical limb ischemia , diabetic foot , percutaneous , creatinine , diabetic nephropathy , dialysis , surgery , angioplasty , diabetes mellitus , stage (stratigraphy) , risk factor , univariate analysis , contrast induced nephropathy , cardiology , revascularization , nephropathy , multivariate analysis , kidney , myocardial infarction , paleontology , biology , endocrinology
Background The aim of this study is to evaluate the risk of contrast induced nephropathy (CIN) in diabetic patients with critical limb ischemia (CLI) and foot ulcers (FUs) treated by percutaneous transluminal angioplasty of lower limbs. Methods The study group was composed of 145 diabetic patients who underwent a limb salvage protocol because of CLI and FUs between 2012 and 2015. All patients received a prophylactic strategy against the administration of contrast medium. Serum creatinine (SCr) levels were evaluated the day of procedure and for 3 days after. CIN was considered in case of increase of 25% of SCr in comparison to baseline value or an absolute increase of at least 0.5 mg/dl without other interfering factors. Results CIN occurred in 9% (14/145) of the cases. In the 1‐year follow‐up SCr returned to baseline values in 10 patients (71 %), 3 patients died (21%), and 1 patient had a major cardiovascular event (7%). No patients required dialysis. The risk was independent of chronic kidney disease stage. The rate of contrast nephropathy in each stage ( X = 0.27) was as follows: 3/20 (15%) in stage 2; 3/66 (4.6%) in stage 3, 7/51 (13.7%) in stage 4; and 1/8 (12.5%) in stage 5. At the univariate analysis factors predicting this risk were anemia (HR 95% 2.5 [CI 1.8‐4.2] P = .039) and heart failure (HR 95% 2.6 [CI 2.1‐4.6] P = .038), while any significant variable was found at multivariate analysis. Conclusions Peripheral percutaneous transluminal angioplasty in diabetic patients with CLI and FUs can be performed with a good safety factor and a low risk of contrast medium toxicity.