The occurrence and influencing factors of post-contrast acute kidney injury in patients with lower extremity arteriosclerosis obliterans after interventional therapy

doi:10.3877/cma.j.issn.2095-5782.2025.04.005

Abstract

Abstract:

Objective

To explore the prevalence and influencing factors of post-contrast acute kidney injury (PC-AKI) in patients with lower extremity arteriosclerosis obliterans (LEASO) after interventional therapy.

Methods

A retrospective analysis was conducted on 550 patients with LEASO who underwent interventional therapy at Zhejiang Provincial People's Hospital between January 1, 2023 and December 31, 2024. Patients were categorized into PC-AKI and non-PC-AKI groups based on the occurrence of PC-AKI. Clinical data were collected and compared. The Cochran-Armitage trend test was applied to assess the relationship between PC-AKI incidence and chronic kidney disease (CKD) stage. Multivariate logistic regression analysis was performed to identify independent predictors of PC-AKI.

Results

PC-AKI occurred in 42 patients (7.64%). The incidence of PC-AKI increased significantly with advancing CKD stage (trend P<0.001). Multivariate logistic regression analysis identified heart failure (OR=5.63, 95% CI：1.58~20.00, P=0.008), acute limb ischemia (ALI) (OR=5.53, 95% CI：1.91~16.01, P=0.002), baseline eGFR<60 mL·min^-1·(1.73 m²)^-1 (OR=2.81, 95% CI：1.08~7.32, P=0.035), and a contrast medium volume-to-eGFR ratio (CGR)≥3 (OR=4.03, 95% CI：1.61~10.09, P=0.003) as independent factors associated with PC-AKI.

Conclusion

PC-AKI is a relatively common complication in LEASO patients after interventional therapy, with incidence increasing in parallel with CKD stage progression. Heart failure, ALI, impaired baseline renal function [eGFR< 60 mL/(min·1.73 m²)], and CGR≥3 are independent predictors of PC-AKI in this population.

Key words: Lower extremity arteriosclerosis obliterans, Interventional therapy, Post-contrast acute kidney injury, Chronic kidney disease

Hanbo Liu, Jun Chen, Jifu Lai, Jinsong Jiang. The occurrence and influencing factors of post-contrast acute kidney injury in patients with lower extremity arteriosclerosis obliterans after interventional therapy[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2025, 13(04): 303-308.

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Figures/Tables 3

临床资料	总体（550例）(n=550)	非PC-AKI组（508例）(n=508)	PC-AKI组（42例）(n=42)	统计值	P值
性别[男性,例(%)]	402 (73.09)	374 (73.62)	28 (66.67)	0.63	0.426
年龄[岁，M(Q₁, Q₃)]	75.00 (68.00, 82.00)	75.00 (68.00, 82.00)	74.50 (67.25, 82.00)	10 999.00	0.738
BMI[kg/m²，M(Q₁, Q₃)]	22.03 (19.61, 24.16)	22.04 (19.69, 24.18)	21.54 (19.55, 23.99)	10 881.00	0.83
吸烟史[例(%)]	247 (44.91)	233 (45.87)	14 (33.33)	1.98	0.159
合并疾病[例(%)]
高血压	404 (73.45)	366 (72.05)	38 (90.48)		0.010 ^a
糖尿病	273 (49.64)	249 (49.02)	24 (57.14)	0.73	0.394
冠心病	100 (18.18)	86 (16.93)	14 (33.33)	5.96	0.015
心力衰竭	16 (2.91)	10 (1.97)	6 (14.29)	16.7	<0.001
血脂异常	507 (92.18)	470 (92.52)	37 (88.10)	0.53	0.467
CLI[例(%)]	167 (30.36)	153 (30.12)	14 (33.33)	0.07	0.794
ALI[例(%)]	24 (4.36)	14 (2.76)	10 (23.81)	36.31	<0.001
血红蛋白(g/L， $x ¯$ ±s)	125.11±21.35	126.10±21.35	113.19±17.60	14 533.50	<0.001
血肌酐[μmol/L, M(Q₁, Q₃)]	82.45 (68.35, 107.40)	80.80 (67.10,101.13)	130.15 (102.15, 269.43)	4 201.00	<0.001
eGFR[ml/(min·1.73 m²), M(Q₁, Q₃)]	75.99 (53.34, 88.14)	77.62 (55.68, 89.59)	34.49 (16.75, 60.14)	17 196.00	<0.001
术后72 h内血肌酐[μmol/L, M(Q₁, Q₃)]	83.50 (68.50, 111.88)	80.60 (67.68, 100.63)	187.00 (145.03, 363.75)	1 497.50	<0.001
CKD分期[例(%)]				68.48	<0.001
正常/G1~2期	374 (68.00)	363 (71.46)	11 (26.19)
G3a期	90 (16.36)	81 (15.94)	9 (21.43)
G3b期	39 (7.09)	34 (6.69)	5 (11.90)
G4期	18 (3.27)	12 (2.36)	6 (14.29)
G5期	29 (5.27)	18 (3.54)	11 (26.19)
院内用药[例(%)]
ACEI/ARB	158 (28.73)	142 (27.95)	16 (38.10)	1.49	0.223
非甾体类抗炎药物	262 (47.64)	237 (46.65)	25 (59.52)	2.09	0.149
CGR≥3[例(%)]	72 (13.09)	50 (9.84)	22 (52.38)	58.02	<0.001
住院时间[d, M(Q₁, Q₃)]	6.00 (5.00, 8.00)	6.00 (5.00, 8.00)	8.00 (6.00, 12.00)	7 206.00	<0.001
术后30 d死亡[例(%)]	5 (0.91)	2 (0.39)	3 (7.14)		0.004^a

临床资料	总体（550例）(n=550)	非PC-AKI组（508例）(n=508)	PC-AKI组（42例）(n=42)	统计值	P值
性别[男性,例(%)]	402 (73.09)	374 (73.62)	28 (66.67)	0.63	0.426
年龄[岁，M(Q₁, Q₃)]	75.00 (68.00, 82.00)	75.00 (68.00, 82.00)	74.50 (67.25, 82.00)	10 999.00	0.738
BMI[kg/m²，M(Q₁, Q₃)]	22.03 (19.61, 24.16)	22.04 (19.69, 24.18)	21.54 (19.55, 23.99)	10 881.00	0.83
吸烟史[例(%)]	247 (44.91)	233 (45.87)	14 (33.33)	1.98	0.159
合并疾病[例(%)]
高血压	404 (73.45)	366 (72.05)	38 (90.48)		0.010 ^a
糖尿病	273 (49.64)	249 (49.02)	24 (57.14)	0.73	0.394
冠心病	100 (18.18)	86 (16.93)	14 (33.33)	5.96	0.015
心力衰竭	16 (2.91)	10 (1.97)	6 (14.29)	16.7	<0.001
血脂异常	507 (92.18)	470 (92.52)	37 (88.10)	0.53	0.467
CLI[例(%)]	167 (30.36)	153 (30.12)	14 (33.33)	0.07	0.794
ALI[例(%)]	24 (4.36)	14 (2.76)	10 (23.81)	36.31	<0.001
血红蛋白(g/L， $x ¯$ ±s)	125.11±21.35	126.10±21.35	113.19±17.60	14 533.50	<0.001
血肌酐[μmol/L, M(Q₁, Q₃)]	82.45 (68.35, 107.40)	80.80 (67.10,101.13)	130.15 (102.15, 269.43)	4 201.00	<0.001
eGFR[ml/(min·1.73 m²), M(Q₁, Q₃)]	75.99 (53.34, 88.14)	77.62 (55.68, 89.59)	34.49 (16.75, 60.14)	17 196.00	<0.001
术后72 h内血肌酐[μmol/L, M(Q₁, Q₃)]	83.50 (68.50, 111.88)	80.60 (67.68, 100.63)	187.00 (145.03, 363.75)	1 497.50	<0.001
CKD分期[例(%)]				68.48	<0.001
正常/G1~2期	374 (68.00)	363 (71.46)	11 (26.19)
G3a期	90 (16.36)	81 (15.94)	9 (21.43)
G3b期	39 (7.09)	34 (6.69)	5 (11.90)
G4期	18 (3.27)	12 (2.36)	6 (14.29)
G5期	29 (5.27)	18 (3.54)	11 (26.19)
院内用药[例(%)]
ACEI/ARB	158 (28.73)	142 (27.95)	16 (38.10)	1.49	0.223
非甾体类抗炎药物	262 (47.64)	237 (46.65)	25 (59.52)	2.09	0.149
CGR≥3[例(%)]	72 (13.09)	50 (9.84)	22 (52.38)	58.02	<0.001
住院时间[d, M(Q₁, Q₃)]	6.00 (5.00, 8.00)	6.00 (5.00, 8.00)	8.00 (6.00, 12.00)	7 206.00	<0.001
术后30 d死亡[例(%)]	5 (0.91)	2 (0.39)	3 (7.14)		0.004^a

CKD分期	例数	总体	男性	女性
正常/G1	126	1 (0.79)	0 (0.00)	1 (3.70)
G2	248	10 (4.03)	9 (4.79)	1 (1.67)
G3a	90	9 (10.00)	7 (11.11)	2 (7.41)
G3b	39	5 (12.82)	2 (10.00)	3 (15.79)
G4	18	6 (33.33)	3 (25.00)	3 (50.00)
G5	29	11 (37.93)	7 (35.00)	4 (44.44)
Z值^a		7.94	6.18	4.84
P值		<0.001	<0.001	<0.001

变量	单因素分析			多因素分析
变量	OR值	95% CI	P值^a	OR值	95% CI	P值^a
女性	1.40	0.71~2.73	0.330
年龄≥60岁	1.48	0.44~4.97	0.523
BMI分类
偏低	参照
正常	1.45	0.49~4.28	0.503
超重	0.94	0.27~3.33	0.924
肥胖	3.42	0.78~14.99	0.103
吸烟史	0.59	0.30~1.15	0.120
高血压	3.69	1.29~10.52	0.015	2.40	0.77~7.48	0.132
糖尿病	1.39	0.73~2.62	0.313
冠心病	2.45	1.24~4.85	0.010	2.18	0.98~4.87	0.057
心力衰竭	8.30	2.86~24.13	<0.001	5.63	1.58~20.00	0.008
血脂异常	0.60	0.22~1.61	0.309
CLI	1.16	0.59~2.26	0.663
ALI	11.03	4.54~26.76	<0.001	5.53	1.91~16.01	0.002
血红蛋白≥110 g/L	0.63	0.32~1.25	0.189
eGFR< 60 mL/(min·1.73m²)	7.06	3.45~14.41	<0.001	2.81	1.08~7.32	0.035
ACEI/ARB	1.59	0.83~3.05	0.166
非甾体类抗炎药物	1.68	0.89~3.19	0.112
CGR≥3	10.08	5.14~19.73	<0.001	4.03	1.61~10.09	0.003

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