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Cited by 20Acute Kidney Injury ResearchChronic Kidney Disease and DiabetesPeripheral Artery Disease Management

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Acute Kidney Injury Following In-Patient Lower Extremity Vascular Intervention

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Safley, David M., Salisbury, Adam C., Tsai, Thomas T., Secemsky, Eric A., Kennedy, Kevin F., Rogers, R. Kevin, Latif, Faisal, Shammas, Nicolas W., Garcia, Lawrence, Cavender, Matthew A., Rosenfield, Kenneth, Prasad, Anand, Spertus, John A.·2021·JACC: Cardiovascular Interventions
DOI 10.1016/j.jcin.2020.10.028PMC PMC8076888
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Abstract

Objectives The authors analyzed data from the NCDR (National Cardiovascular Data Registry) PVI Registry and defined acute kidney injury (AKI) as increased creatinine of ≥0.3 mg/dl or 50%, or a new requirement for dialysis after PVI. Background AKI is an important and potentially modifiable complication of peripheral vascular intervention (PVI). The incidence, predictors, and outcomes of AKI after PVI are incompletely characterized. Methods A hierarchical logistic regression risk model using pre-procedural characteristics associated with AKI was developed, followed by bootstrap validation. The model was validated with data submitted after model creation. An integer scoring system was developed to predict AKI after PVI. Results Among 10,006 procedures, the average age of patients was 69 years, 58% were male, and 52% had diabetes. AKI occurred in 737 (7.4%) and was associated with increased in-hospital mortality (7.1% vs. 0.7%). Reduced glomerular filtration rate, hypertension, diabetes, prior heart failure, critical or acute limb ischemia, and pre-procedural hemoglobin were independently associated with AKI. The model to predict AKI showed good discrimination (optimism corrected c-statistic = 0.68) and calibration (corrected slope = 0.97, intercept of -0.07). The integer point system could be incorporated into a useful clinical tool because it discriminates risk for AKI with scores ≤4 and ≥12 corresponding to the lower and upper 20% of risk, respectively. Conclusions AKI is not rare after PVI and is associated with in-hospital mortality. The NCDR PVI AKI risk model, including the integer scoring system, may prospectively estimate AKI risk and aid in deployment of strategies designed to reduce risk of AKI after PVI.

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Metadata

Authors
Safley, D. M., Salisbury, A. C., Tsai, T. T., Secemsky, E. A., Kennedy, K. F., Rogers, R. K., Latif, F., Shammas, N. W., Garcia, L., Cavender, M. A., Rosenfield, K., Prasad, A., & Spertus, J. A.
Affiliations
  • Saint Luke's Hospital (US)
  • Kaiser Permanente (US)
  • Beth Israel Deaconess Medical Center (US)
  • University of Colorado Anschutz (US)
  • Oklahoma City VA Medical Center (US)
  • Midwest Cardiovascular Research Foundation (US)
  • Tufts University (US)
  • University of North Carolina at Chapel Hill (US)
  • Massachusetts General Hospital (US)
  • The University of Texas at San Antonio Health Science Center (US)
Corresponding author
Safley, David M.
ORCID
Venue
JACC: Cardiovascular Interventions
Publisher
Elsevier BV
Published
2021-02
Volume
14
Issue
3
Pages
333-341
ISSN
  • 1876-7605 (ISSN-L)
  • 1936-8798
DOI
10.1016/j.jcin.2020.10.028
PMC
PMC8076888
OpenAlex
W3126633676
Cited by
20
References
40
Citations by year
2026: 2 · 2025: 6 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 3
FWCI
2.06
Type
journal article
Language
en
Open access
Licence
Locations
  • JACC: Cardiovascular Interventions (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
American College of Cardiology Foundation
Topics
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
Keywords
acute kidney injury, peripheral vascular intervention, risk prediction model, in-hospital mortality, risk scoring, reduced glomerular filtration rate, diabetes mellitus, acute limb ischemia, dialysis requirement
MeSH terms
Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Registries, Retrospective Studies, Risk Factors, Incidence, Treatment Outcome, Risk Assessment, Lower Extremity, Acute Kidney Injury

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