Loss of Kidney Function after Endovascular Treatment of Peripheral Arterial Disease

Background: Administration of radiocontrast during endovascular procedures for peripheral arterial disease (PAD) may cause acute kidney injury, which generally recovers with supportive treatment. Long-term effects of endovascular procedures on renal function remain to be investigated. Method: This retrospective observational cohort study includes all patients who newly presented to the vascular surgery outpatient clinic with Rutherford class II or III PAD and who were treated with either supervised exercise therapy or endovascular interventions. Changes in estimated glomerular filtration rates (eGFR) after 1 year were compared between the 2 treatment groups. Multivariate regression analysis and propensity score matched paired analysis were done to correct for potential confounders. Results: One year after treatment, eGFR was reduced by 8.6 mL/min (95% confidence interval [CI], 7.3-9.9, P <0.001) after endovascular intervention (n = 284) and by 1.7 mL/min (95% CI, 0.9-25, P <0.001) after supervised exercise therapy (n = 299). After correction for potential confounders, endovascular interventions were associated with 9.2 mL/min (95% CI, 5.9-12.4, P <0.001) more renal decline compared to exercise therapy. Similar results were found in the propensity score matched paired analysis. Conclusions: Endovascular procedures for PAD are associated with clinically relevant and long-term loss of kidney function.