Original title: Acute kidney Injury in Patients UIT Chronic Kidney Disease Undergoing Internal Carotid Artery Stent Implantation. Reference: Michael Donahue, et al J Am Coll Cardiol Interv 2015;8:1506-14

Post procedural acute kidney injury (AKI) in patients with chronic kidney disease has been associated with major events; however, the cause is still unclear.

This study analyzed 126 patients presenting a glomerular filtration rate of <60ml/min/1.73 m2 undergoing carotid stenting.
AKI was considered an increase of ≥0.3 mg/dl in the serum creatinine concentration at 48 hrs. or the need for dialysis.

Prior procedure, patients were protected with hydration and N-Acetylcysteine when glomerular filtration was between 30 and 59 ml/min/1.73 m2 or with hydration, N-Acetylcysteine plus RenalGuard when it was <30ml/min/1.73 m2.

Hemodynamic depression was defined as periprocedural systolic blood pressure <90 mm Hg or heart rate <60 beats/min during the first 24 hrs.
AKI occurred in 26 patients (20.6%). The AKI group had more men, active smokers, anemic and they more often required predilation and larger stent diameters.

Contrast volume was similar in the group with no AKI. Hemodynamic depression and duration were higher in the AKI group (65% vs. 35% OR 3.50; CI 95% 1.42 to 8.68; p=0.005).

There was a significant positive correlation between hemodynamic depression time and the increase of creatinine serum (p<0.001). The threshold of hemodynamic depression duration for AKI development was 2.5 min (sensitivity 54%, specificity 82%).

In hospital evolution and at 30 day follow up there was higher mortality in the AKI group (3 of 26 [11.5%] vs. 2 of 100 [2%]; p= 0.0026). There were no differences in stroke or major bleeding.

Conclusion
Acute kidney injury in patients with chronic kidney disease undergoing carotid stenting is mostly associated with periprocedural hemodynamic depression (hypotension and bradycardia) and is associated to major mortality at 30 days.

Editorial Comment
Acute kidney injury is frequent and is basically associated to hemodynamic management during procedure. Hypotension and bradycardia were more serious in lesions with carotid sinus compromise. Maintaining heartbeat and blood pressure during procedure using atropine and /or vasopressors helps reduce mortality in patients with chronic kidney disease undergoing carotid stenting.

Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation – Argentina