Prognostic Impact of Post-Contrast Acute Kidney Injury in Patients With Chronic Kidney Disease Undergoing Endovascular Aortic Repair

Background: Post-contrast acute kidney injury (PC-AKI) has been regarded as a serious complication after contrast administration, particularly in patients with chronic kidney disease (CKD). However, the prognostic significance of PC-AKI following endovascular aortic repair (EVAR) remains controversial due to heterogeneity in previous study populations. This study evaluated the association between PC-AKI and longitudinal changes in postoperative renal function and mortality in a well-defined CKD cohort undergoing EVAR. Methods: We conducted a single-center retrospective study of patients with CKD undergoing elective, primary, and non-complex infrarenal EVAR. Patients were classified according to the presence or absence of PC-AKI. Longitudinal changes in serum creatinine after EVAR, dialysis initiation, all-cause mortality, and the association between contrast volume and PC-AKI were evaluated. Results: Among 479 EVAR procedures, 164 patients with CKD were included, of whom 17 (10.4%) developed PC-AKI. The linear mixed-effects model showed a significant group-by-time interaction ( P < .001). Serum creatinine remained significantly higher in the PC-AKI group than in the non-PC-AKI group at all postoperative time points. However, in the PC-AKI group, model-adjusted mean serum creatinine decreased significantly from 1.75 mg/dL in the postoperative period to 1.46 mg/dL at 12 months with an estimated change of −0.29 mg/dL (95% CI, −0.50 to −0.09; P = .003). No significant differences were observed in dialysis initiation (5.9% vs 0.7%; P = .197) or all-cause mortality (29.4% vs 23.8%; P = .565). Kaplan-Meier analysis showed no significant difference in overall survival between the groups (log-rank P = .246). In the multivariable analysis, contrast volume was not independently associated with PC-AKI (odds ratio [OR], 1.00; 95% CI, 0.98-1.01; P = .845), whereas lower preoperative estimated glomerular filtration rate remained significantly associated with PC-AKI (OR, 1.06 per 1 mL/min/1.73 m 2 decrease; 95% CI, 1.01-1.12; P = .018). Conclusion: In this study, PC-AKI may not necessarily be associated with adverse subsequent renal or survival outcomes. In addition, underlying renal vulnerability may be more closely associated with the development of PC-AKI than contrast volume alone. While PC-AKI should not be disregarded, judicious contrast use to ensure appropriate assessment may be reasonable even in patients with CKD. Clinical Impact Post-contrast acute kidney injury (PC-AKI) occurred in approximately 10% of patients with chronic kidney disease (CKD) undergoing elective, primary, non-complex infrarenal endovascular aortic repair (EVAR). Although serum creatinine remained higher in patients with PC-AKI at all postoperative time points, it decreased significantly from the postoperative period to 12 months. No significant differences were observed in dialysis initiation or overall survival between the groups. In addition, contrast volume was not independently associated with PC-AKI, whereas lower preoperative estimated glomerular filtration rate was. These findings suggest that contrast use should not be excessively restricted solely because of concerns regarding PC-AKI, and that judicious contrast use to ensure appropriate assessment may be reasonable even in patients with CKD.