Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
Br J Surg. 2021 Mar 12;108(2):152-159. doi: 10.1093/bjs/znaa057.
The incidence of, and risk factors for, acute kidney injury (AKI) after endovascular intervention for peripheral artery disease (PAD) remain unknown. The aim of this study was to assess the proportion of patients who develop AKI and explore the risk factors.
Prospectively collected data on patients undergoing femoropopliteal endovascular intervention for symptomatic PAD across three vascular centres were analysed. The proportion of patients developing AKI (according to the Kidney Disease Improving Global Outcomes definition) within 48 h, and the proportion developing the composite Major Adverse Kidney Events (MAKE) endpoints (death, dialysis, drop in estimated glomerular filtration rate at least 25 per cent) at 30 days (MAKE30) and remains 90 days (MAKE90) were calculated. Multivariable regression analysis was used to assess predictors of AKI, and the association between AKI and death.
Some 2041 patients were included in the analysis. AKI developed in 239 patients (11.7 per cent), with 47 (2.3 per cent) requiring dialysis within 30 days, and 18 (0.9 per cent) requiring ongoing dialysis. The MAKE30 and MAKE90 composite endpoints were reached in 358 (17.5 per cent) and 449 (22.0 per cent) patients respectively. Risk factors for AKI were age, sex, congestive heart failure, chronic limb-threatening ischaemia, emergency procedure, and pre-existing chronic kidney disease. AKI, dementia, congestive heart failure, and major amputation were risk factors for medium-term mortality.
AKI is a common complication after intervention for PAD and is associated with medium-term mortality.
外周动脉疾病（PAD）血管内介入治疗后急性肾损伤（AKI）的发生率和危险因素尚不清楚。本研究旨在评估发生 AKI 的患者比例，并探讨其危险因素。
对三个血管中心接受股腘动脉血管内介入治疗的有症状 PAD 患者的前瞻性收集数据进行了分析。计算了在 48 小时内发生 AKI（根据肾脏病改善全球结局定义）的患者比例，以及在 30 天（MAKE30）和 90 天（MAKE90）时发生复合主要不良肾脏事件（MAKE）终点（死亡、透析、估计肾小球滤过率下降至少 25%）的患者比例。采用多变量回归分析评估 AKI 的预测因素以及 AKI 与死亡之间的关系。
共纳入 2041 例患者。239 例（11.7%）发生 AKI，其中 47 例（2.3%）在 30 天内需要透析，18 例（0.9%）需要持续透析。30 天和 90 天的 MAKE30 和 MAKE90 复合终点分别达到 358 例（17.5%）和 449 例（22.0%）。AKI 的危险因素为年龄、性别、充血性心力衰竭、慢性肢体威胁性缺血、急诊手术和预先存在的慢性肾脏病。AKI、痴呆、充血性心力衰竭和大截肢是中期死亡率的危险因素。
AKI 是 PAD 介入治疗后的常见并发症，与中期死亡率相关。
