The Impact of Contrast Media Volume Used During Endovascular Aneurysm Repair on Long Term Renal Function
Jennifer Grom, B.S., Rami Tadros, Melissa Baldwin, Melissa Tardiff, Anthony Bui, Brian Ratliff, PhD, Alex Sher, BS, Martin Kang, BS, Lucia Qian, BS.
Mount Sinai Hospital, New York, NY, USA.
Objective(s): We investigated the degree to which the volume of contrast used during an endovascular aneurysm repair (EVAR) predicts post-procedural short and long-term renal dysfunction.
Methods: A review of 101 patients from 2012-2016 was performed. Volume of contrast (Iopamidol 300) used during EVAR, as well as, pre-operative and post-operative renal function at 24 hours, 48-72 hours, 1-3 months, 6 months, 1 year, and 2 years was determined. Multivariate analyses were performed to examine the relationship between Chronic Kidney Disease (CKD) progression and volume of contrast used, adjusting for pre-operative renal function and comorbidities including: obesity, cardiac comorbidities, preoperative renal insufficiency, diabetes, gender, hypertension, hyperlipidemia, smoking, and age at surgery.
The mean age was 74. 4 + 8. 9 years SD, and 80 (78. 4%) patients were male. There was no significant difference in intraoperative contrast media use based on preoperative renal function status with the patients with normal preoperative renal function receiving (mean 204. 2 + 97. 8 mL SD) of contrast and patients with preoperative renal insufficiency receiving (mean 188. 6 + 104. 1 mL SD) of contrast. Comorbidity data was gathered and accounted for in subsequent analysis. Preoperatively, 51 patients had normal kidney function and 50 had renal insufficiency. For every additional 50 mL of contrast, patients were 72. 3% more likely to progress one CKD stage at 48-72 hours post-procedure (p < . 0. 001), 56. 9% more likely at 1-3 months (p = 0. 002), 53. 0% more likely at 6 months (p= 0. 002), 82. 3% more likely at 1 year (p < 0. 001), and 77. 7% more likely at 2 years (p-value < 0. 001). For patients with preoperative renal insufficiency, every additional 50 mL of contrast was associated with a 68. 7% increase in the odds of a CKD stage progression at 48-72 hours (p=0. 01) and a 49. 7% increase at 2 years (p=0. 05). Within 3 years post-EVAR, 20% of patients progressed at least one full CKD stage.
Our findings suggest the volume of contrast used during EVAR significantly predicts progression of CKD. Additionally, conservative contrast administration is essential to kidney health and contrast alternatives should be explored.
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