Increased risk of contrast-induced acute kidney injury in patients with pulmonary thromboembolism

Figures & data

Figure 1. The flow diagram of the study.

Table 1. The eligibility criteria for the study.

Eligibility criteria
Inclusion criteria
Age ≥ 18
Definite diagnosis of PT with CTPA
Hospitalization for a minimum of 72 h following the diagnosis
Exclusion criteria
Any concomitant factors which might cause or contribute to an acute kidney injury other than CIAKI (i.e., dehydration, hypovolemia, hypotension/shock, urinary obstruction)
History of nephrotoxic drugs excluding low-dose aspirin therapy (i.e., 100–300 mg daily)
No record of the baseline serum creatinine
Missing relevant data

Table 2. Demographics, basal renal function and classical CIAKI risk factors of the study population.

Parameter	Average/frequency
Demographics
Age (years)^a	70.3 ± 13.8
Gender (F:M)^b	70 (57.4%):52 (42.6%)
Basal renal function
Creatinine (mg/dL)^a	0.89 ± 0.37
MDRD-eGFR (mL/min/1.73 m^2)^a	82.0 ± 30.5
Classical CIAKI risk factors
Diabetes mellitus^b	21 (17.2%)
Diabetic nephropathy^b	1 (0.8%)
Congestive heart failure^b	33 (27%)
Stage 3–4 chronic kidney disease^b	24 (19.6%)
Hypertension^b	90 (73.8%)
ASA use^b,c	18 (14.8%)
ACEI-ARB use^b,d	74 (60.7%)
Systolic blood pressure (mmHg)^a	117.2 ± 22.4
Diastolic blood pressure (mmHg)^a	72.4 ± 12.7
Ejection fraction (%)^a	55.6 ± 11.2
Hemoglobin (g/dL)^a	12.5 ± 2.1
Albumin (g/dL)^a	3.43 ± 0.60

Notes: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; ASA, acetylsalicylic acid; CIAKI, contrast-induced acute kidney injury; MDRD-eGFR, estimated glomerular filtration rate according to “Modification of Diet in Renal Disease” formula.

^aMean ± SD.

^bNumber (%).

^cLow-dose aspirin therapy (i.e., 100–300 mg daily).

^dACEIs and ARBs with different types and different dosing schedules were used.

Table 3. Baseline ABG, transthoracic echocardiography, and CTPA findings of the study population.

Parameter		Average/frequency
Arterial blood gas analysis
pH^a		7.44 ± 0.59
(mmHg)^a		66.5 ± 18.1
(mmHg)^a		35.6 ± 7.4
cHCO3 (mEq/L)^a		24.1 ± 4.1
Transthoracic echocardiography
Mean pulmonary artery pressure (mmHg)^a		41.1 ± 10.6
Computed tomography pulmonary angiography
Small pulmonary artery involvement^b		96 (78.7%)
Large pulmonary artery involvement^b		26 (21.3%)

^aMean ± SD.

^bNumber (%).

Table 4. Comparison of CIAKI (+) and CIAKI (−) groups with respect to their demographics, renal functions and classical CIAKI risk factors.

Parameter		CIAKI (+)	CIAKI (−)	p
Number of patients^a		16 (13.1%)	106 (86.9%)	–
Demographics
Age (years)^b		79.5 ± 10.2	68.5 ± 13.8	0.004^c
Gender (F:M)^a		10 (62.5%):6 (37.5%)	60 (56.6%):46 (43.4%)	0.789
Renal functions
Basal creatinine (mg/dL)^b		0.98 ± 0.75	0.88 ± 0.27	0.338
Basal MDRD-eGFR (mL/min/1.73 m^2)^b		78.8 ± 30.1	82.4 ± 30.7	0.662
Peak creatinine (mg/dL)^b		2.34 ± 1.40	0.96 ± 0.28	0.001^c
Classical CIAKI risk factors
Diabetes mellitus^a		4 (25%)	17 (16%)	0.380
Diabetic nephropathy^a		1 (6.3%)	–	–
Congestive heart failure^a		9 (56.3%)	24 (22.6%)	0.012^c
Stage 3–4 chronic kidney disease^a		4 (25%)	20 (18.9%)	0.517
Hypertension^a		14 (87.5%)	76 (71.4%)	0.233
ASA use^a,d		3 (18.8%)	15 (14.2%)	0.852
ACEI-ARB use^a,e		14 (87.5%)	60 (56.6%)	0.026^c
Systolic blood pressure (mmHg)^b		117.8 ± 26.0	117.1 ± 22.0	0.913
Diastolic blood pressure (mmHg)^b		71.2 ± 12.1	72.5 ± 12.8	0.696
Ejection fraction (%)^b		50.0 ± 13.4	56.0 ± 10.7	0.077
Hemoglobin (g/dL)^b		11.6 ± 2.17	12.6 ± 2.18	0.075
Albumin (g/dL)^b		3.29 ± 0.89	3.45 ± 0.54	0.412

Notes: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; ASA, acetylsalicylic acid; CIAKI, contrast-induced acute kidney injury; MDRD-eGFR, estimated glomerular filtration rate according to “Modification of Diet in Renal Disease” formula.

^aNumber (%).

^bMean ± SD.

^cp < 0.05.

^dLow-dose aspirin therapy (i.e., 100–300 mg daily).

^eACEIs and ARBs with different types and different dosing schedules were used.

Table 5. Comparison of CIAKI (+) and CIAKI (−) groups with respect to their baseline ABG, transthoracic echocardiography, and CTPA findings.

Parameter		CIAKI (+)	CIAKI (−)		p
Arterial blood gas analysis
pH^a		7.40 ± 0.74	7.45 ± 0.55		0.024^b
(mmHg)^a		55.8 ± 17.4	67.8 ± 17.9		0.062
(mmHg)^a		35.0 ± 6.9	35.7 ± 7.5		0.790
cHCO3 (mEq/L)^a		22.9 ± 4.5	24.2 ± 4.0		0.347
Transthoracic echocardiography
Mean pulmonary artery pressure (mmHg)^a		44.0 ± 14.1	40.7 ± 10.0		0.326
Computed tomography pulmonary angiography
Small pulmonary artery involvement^c		13 (81.2%)	83 (78.3%)		NA^d
Large pulmonary artery involvement^c		3 (18.8%)	23 (21.7%)		NA^d

Notes: ^aMean ± SD.

^bp < 0.05.

^cNumber (%).

^dNot available, no comparison was performed.