Abstract：
BACKGROUND: Coronary angiography and percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD) is associated with increased risk of contrast induced nephropathy (CIN) and requirement for renal replacement therapy (RRT).
OBJECTIVE: We aimed to evaluate our single center experience of ultra-low contrast PCI in patients with CKD and to characterize 1 year outcomes.
METHODS: We performed a retrospective analysis of ultra-low contrast PCI at our institution between 2016 and 2022. Patients with CKD3b-5 (eGFR <45 mL/min/1.73m2), not on RRT who underwent ultra-low contrast PCI ( < 30 mL of contrast during PCI) were included. Primary outcomes included change in eGFR post-procedurally, and death, RRT requirement, and major adverse cardiac events (MACE) at 1 year follow-up.
RESULTS: One hundred patients were included in the study. The median age was 67 years old and 28% were female. The median baseline eGFR was 21.5 mL/min/1.73m2 (IQR 14.08-32.0 mL/min/1.73m2). A median of 8.0 mL (IQR 0-15 mL) of contrast was used during PCI. Median contrast use to eGFR ratio was 0.37 (IQR 0-0.59). There was no significant difference between pre-and postprocedure eGFR (p = 0.84). At 1 year, 8% of patients died, 11% required RRT and 33% experienced MACE. The average time of RRT initiation was 7 months post-PCI. Forty-four patients were undergoing renal transplant evaluation, of which 17 (39%) received a transplant.
CONCLUSIONS: In patients with advanced CKD, ultra-low contrast PCI is feasible and safe with minimal need for peri-procedural RRT. Moreover, ultra-low contrast PCI may allow for preservation of renal function in anticipation of renal transplantation.
OBJECTIVE: We aimed to evaluate our single center experience of ultra-low contrast PCI in patients with CKD and to characterize 1 year outcomes.
METHODS: We performed a retrospective analysis of ultra-low contrast PCI at our institution between 2016 and 2022. Patients with CKD3b-5 (eGFR <45 mL/min/1.73m2), not on RRT who underwent ultra-low contrast PCI ( < 30 mL of contrast during PCI) were included. Primary outcomes included change in eGFR post-procedurally, and death, RRT requirement, and major adverse cardiac events (MACE) at 1 year follow-up.
RESULTS: One hundred patients were included in the study. The median age was 67 years old and 28% were female. The median baseline eGFR was 21.5 mL/min/1.73m2 (IQR 14.08-32.0 mL/min/1.73m2). A median of 8.0 mL (IQR 0-15 mL) of contrast was used during PCI. Median contrast use to eGFR ratio was 0.37 (IQR 0-0.59). There was no significant difference between pre-and postprocedure eGFR (p = 0.84). At 1 year, 8% of patients died, 11% required RRT and 33% experienced MACE. The average time of RRT initiation was 7 months post-PCI. Forty-four patients were undergoing renal transplant evaluation, of which 17 (39%) received a transplant.
CONCLUSIONS: In patients with advanced CKD, ultra-low contrast PCI is feasible and safe with minimal need for peri-procedural RRT. Moreover, ultra-low contrast PCI may allow for preservation of renal function in anticipation of renal transplantation.
摘要：
背景：慢性肾脏病（CKD）患者的冠状动脉造影和经皮冠状动脉介入治疗（PCI）与造影剂肾病（CIN）的风险增加和肾脏替代治疗（RRT）的需要相关。
目的：我们旨在评估我们的单中心CKD患者超低对比PCI治疗的经验，并描述1年的预后。
方法：我们在2016年至2022年期间对我们机构的超低对比PCI进行了回顾性分析。CKD3b-5患者（eGFR<45mL/min/1.73m2），未接受RRT的患者接受超低对比PCI(PCI期间对比剂<30mL)。主要结果包括程序后eGFR的变化，和死亡,RRT要求,和1年随访时的主要不良心脏事件（MACE）。
结果：100名患者被纳入研究。中位年龄为67岁，28％为女性。基线eGFR中值为21.5mL/min/1.73m2(IQR14.08-32.0mL/min/1.73m2)。PCI期间使用的造影剂中位数为8.0mL（IQR0-15mL）。使用eGFR的中位数对比率为0.37（IQR0-0.59）。术前和术后eGFR之间没有显着差异（p=0.84）。在1年,8%的患者死亡，11%需要RRT，33%经历MACE。RRT起始时间平均为PCI术后7个月。44例患者接受肾移植评估,其中17人（39%）接受了移植。
结论：在晚期CKD患者中，超低对比度PCI是可行和安全的，对围手术期RRT的需求最小。此外，超低对比度PCI可以在预期的肾移植中保留肾功能。
目的：我们旨在评估我们的单中心CKD患者超低对比PCI治疗的经验，并描述1年的预后。
方法：我们在2016年至2022年期间对我们机构的超低对比PCI进行了回顾性分析。CKD3b-5患者（eGFR<45mL/min/1.73m2），未接受RRT的患者接受超低对比PCI(PCI期间对比剂<30mL)。主要结果包括程序后eGFR的变化，和死亡,RRT要求,和1年随访时的主要不良心脏事件（MACE）。
结果：100名患者被纳入研究。中位年龄为67岁，28％为女性。基线eGFR中值为21.5mL/min/1.73m2(IQR14.08-32.0mL/min/1.73m2)。PCI期间使用的造影剂中位数为8.0mL（IQR0-15mL）。使用eGFR的中位数对比率为0.37（IQR0-0.59）。术前和术后eGFR之间没有显着差异（p=0.84）。在1年,8%的患者死亡，11%需要RRT，33%经历MACE。RRT起始时间平均为PCI术后7个月。44例患者接受肾移植评估,其中17人（39%）接受了移植。
结论：在晚期CKD患者中，超低对比度PCI是可行和安全的，对围手术期RRT的需求最小。此外，超低对比度PCI可以在预期的肾移植中保留肾功能。
